[Current use of bisphosphonates in clinical oncology]. / Primjena bifosfonata u internistickoj onkologiji.

Bisphosphonates represent nowadays a standard therapy of tumor induced hypercalcemia and are progressively more used in the treatment of tumor bone metastatic disease. Among several bisphosphonates, pamidronate is one of the most commonly used in clinical practice, so we also used it in succesful treatment of patients with breast cancer bone metastases. It has been shown that pamidronate reduces the frequency of hypercalcemia, bone pain and pathological fractures, although the mechanisms by which these effects are achieved are not completely clarified. Bisphosphonates are also important not only in treating patients with present metastases but also in prevention, or at least, delay of bone metastases onset. Recently, there are clinical trials examining the so called adjuvant therapy, that means the use of bisphosphonates in prevention of bone metastases in high risk breast cancer patients without distant metastases. In addition to breast cancer, multiple myeloma is another area of successful bisphosphonate application. In this paper we present some of the clinical results following the use of pamidronate in breast cancer- and hypernephroma-patients with hypercalcemia.

Changes in serum lipid and lipoprotein levels in postmenopausal patients with node-positive breast cancer treated with tamoxifen.

Tamoxifen has been used for a long time as an adjuvant hormonal treatment in breast cancer patients. We studied 62 newly diagnosed postmenopausal women, aged 50-79 years, with node-positive breast cancer and receiving adjuvant tamoxifen (20 mg per day). Total serum cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, VLDL-cholesterol, apo AI, apo AII, apo B and Lp(a) were determined before the surgery and 3, 6, 9, 12 and 24 months after starting tamoxifen treatment. Tamoxifen significantly reduced total serum cholesterol (6.13+/-1.20 mmol/L vs 5.21+/-1.05 mmol/L) (P <0.01), LDL-cholesterol (3.72+/-0.70 mmol/L vs 2.93+/-0.51) (P <0.01) and Lp(a) (0.11+/-0.07 g/L vs 0.02+/-0.01 g/L) (P < 0.01). There were no changes in triglycerides or HDL-cholesterol serum levels during tamoxifen treatment. The results indicate that an additional beneficial effect of adjuvant tamoxifen therapy may be that it decreases cardiovascular risk in such patients.

[Hormonal therapy with aromatase inhibitor in advanced breast cancer]. / Hormonsko lijecenje uznapredovalog raka dojke blokatorom aromataze.

We investigated the aminogluthetimide therapy effect on 30 postmenopausal women with advanced breast cancer previously treated with tamoxifen as a first-line hormonal treatment. Aminogluthetimide exhibits anticancer effect by inhibition of aromatase enzyme which plays a key role in the conversion of androgen to estrogen in peripheral adipose tissue. This pathway presents the main source of estrogen in postmenopausal women. Mean duration of the treatment was 14.3 months. Complete remission has been achieved in 10% of all patients, and partial remission in 16.6%. Mean duration of free intervals was 16.1 months in the group with ER+/PgR+ hormonal status, which is significantly longer compared to the ER+/PgR- and ER-/PgR+ groups where it was 11.8 months (p < 0.01). Aminogluthetimide treatment led to significant decrease in estradiol (E2) and dehydroepiandrosterone-sulphate (DHAS) levels in plasma. Thus, the effect of aminogluthetimide therapy as a second-line hormonal therapy has a benefit in the treatment of metastatic hormon-dependent breast cancer patients.