Comparison of the systemic and intratumoral effects of tamoxifen and the aromatase inhibitor vorozole in postmenopausal patients with primary breast cancer.

PURPOSE: To determine biologic differences, if any, between presurgical endocrine treatment with an aromatase inhibitor (vorozole) and tamoxifen in patients with postmenopausal primary breast cancer. PATIENTS AND METHODS: Randomization was to 12 weeks of 2.5 mg of vorozole per day or 20 mg of tamoxifen per day, both orally. Clinical response was assessed monthly together with serum sex hormone binding globulin (SHBG), luteinizing hormone (LH), follicle-stimulating hormone (FSH), estrogens (E1, E2, and E1S), lipids, insulin-like growth factor-1 (IGF-1), and bone metabolites (CrossLaps CTx). Tissue samples for Ki67, apoptotic index (AI), estrogen receptor, and progesterone receptor were collected at 0, 2, and 12 weeks. RESULTS: Ki67 fell by 58% and 43% (means) at 2 weeks in the vorozole and tamoxifen patients, respectively (P =.13). In the vorozole group, the correlations of proportional changes in Ki67 at 2 weeks with tumor volume changes and clinical response at 12 weeks were not significant (P =.09) and marginally significant (P =.04), respectively. Serum lipids did not differ between groups. Serum levels of EI, E2, and E1S were suppressed markedly by vorozole, whereas levels of SHBG increased and LH and FSH fell significantly with tamoxifen. IGF-1 levels fell significantly with tamoxifen (P =.001) compared with the nonsignificant rise with vorozole. Twelve-week CTx values fell by 19% with tamoxifen (P =.006) and rose by 11% with vorozole (P =.15). CONCLUSION: The correlation with vorozole of Ki67 with volume and clinical response supports this as an intermediate marker. The nonsignificant effects on bone and lipid metabolism by the aromatase inhibitor may be important to consider for adjuvant and potential prevention strategies.

Emotion-related primary and secondary appraisals, adjustment and coping: associations in women awaiting breast disease diagnosis.

OBJECTIVE: Different emotions are to some extent associated with different ways of coping. Cognitive processes involved in determining emotional reactions may influence coping (perhaps through directing attention or generating salient information). This study explored possible appraisal-coping associations by examining whether a set of appraisal components identified in emotion theory were also associated with coping. DESIGN: The study examined concurrent associations between appraisal components, emotional adjustment, and coping in 148 women with suspected breast disease. METHOD: Questionnaire measures of primary and secondary appraisal components identified in emotion theory, anxiety, depression, and coping were sent to women during the waiting period between GP referral and attendance at a 'one-stop' breast-disease diagnosis clinic. RESULTS: Consistent with expectations, appraisal components were associated with both emotions and coping. Elevated anxiety was associated with appraisals of low emotion-focused coping potential; avoidance coping was associated with motivational incongruence, self-accountability, and pessimistic appraisal of emotion-focused coping potential; acceptance/resignation coping was associated with self-accountability and pessimistic appraisals of both future expectancy and emotion-focused coping potential. CONCLUSION: This study presents a theoretically driven approach to exploring associations between emotions and adjustment efforts. In keeping with expectations, a number of appraisal components identified in emotion theory were found to be associated with both emotion and coping.