Abstract
We utilized data from the comparison group of the Women’s Healthy Eating and Living randomized trial to investigate an “a priori” hypothesis suggested by CYP2D6 studies that hot flashes may be an independent predictor of tamoxifen efficacy. A total of 1551 women with early stage breast cancer were enrolled and randomized to the comparison group of the WHEL multi-institutional trial between 1995 and 2000. Their primary breast cancer diagnoses were between 1991 and 2000. At study entry, 864 (56%) of these women were taking tamoxifen, and hot flashes were reported by 674 (78%). After 7.3 years of follow-up, 127 of those who took tamoxifen at baseline had a confirmed breast cancer recurrence. Women who reported hot flashes at baseline were less likely to develop recurrent breast cancer than those who did not report hot flashes (12.9% vs 21%, P = 0.01). Hot flashes were a stronger predictor of breast cancer specific outcome than age, hormone receptor status, or even the difference in the stage of the cancer at diagnosis (Stage I versus Stage II). These findings suggest an association between side effects, efficacy, and tamoxifen metabolism. The strength of this finding suggests that further study of the relationship between hot flashes and breast cancer progression is warranted. Additional work is warranted to clarify the mechanism of hot flashes in this setting.
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The Women’s Healthy Eating and Living (WHEL) Study was initiated with the support of the Walton Family Foundation and continued with funding from NCI grant CA 69375.
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The Women’s Healthy Eating and Living (WHEL) Study Group: WHEL Study Coordinating Center: University of California, San Diego, Cancer Prevention and Control Program, San Diego, California: Dr. John P. Pierce (Principal Investigator), Dr. Barbara A. Parker (Medical Director), Dr. Wayne Bardwell, Susan Faerber, Shirley W. Flatt, Sheila Kealey, Dr. Loki Natarajan, Vicky Newman, Dr. Cheryl L. Rock; Whel Study Clinic Sites: Center For Health Research, Portland, Oregon: Dr. Njeri Karanja, Dr. Mark Rarick; Kaiser Permanente Northern California, Oakland, California: Dr. Bette J. Caan, Dr. Lou Fehrenbacher; Northern California Cancer Center, Palo Alto, California: Dr. Marcia L. Stefanick, Dr. Robert Carlson; University Of Arizona, Tucson And Phoenix, Arizona: Dr. Cynthia Thomson, Dr. James Warnecke; University Of California, Davis, Davis, California: Dr. Ellen B. Gold, Dr. Sidney Scudder; University Of California, San Diego Cancer Center, San Diego, California: Dr. Kathryn A. Hollenbach, Dr. Linda Wasserman; University Of Texas M. D. Anderson Cancer Center, Houston, Texas: Dr. Lovell A. Jones, Dr. Richard Theriault.
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Mortimer, J.E., Flatt, S.W., Parker, B.A. et al. Tamoxifen, hot flashes and recurrence in breast cancer. Breast Cancer Res Treat 108, 421–426 (2008). https://doi.org/10.1007/s10549-007-9612-x
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DOI: https://doi.org/10.1007/s10549-007-9612-x