We performed a meta-analysis of three sub-studies of the randomized Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial to determine the effects of exemestane and tamoxifen on bone health.
Patients received exemestane or tamoxifen as adjuvant therapy for hormone receptor–positive breast cancer. Bone mineral density (BMD) was assessed at baseline and after 12 and 24 months of treatment. Bone turnover markers were also measured.
Patients receiving tamoxifen showed a mean increase from baseline in lumbar spine BMD of 1.2% at month 12 and 0.2% at month 24. Patients receiving exemestane showed a mean decrease from baseline of 2.6% after 12 months and 3.5% after 24 months. There were significant differences in the changes in lumbar spine BMD between treatment groups (P < 0.0001 at both time points). Changes in BMD from baseline at the total hip were also significantly different between exemestane and tamoxifen (P < 0.05 at both time points). Bone turnover markers decreased from baseline with tamoxifen and increased with exemestane.
Exemestane resulted in decreases in BMD and increases in bone turnover markers. BMD increased and bone turnover markers decreased with tamoxifen.
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The authors would like to acknowledge Dr Luc Dirix for his help with the Belgian data. Editorial assistance for this paper was provided by Caroline Masterman at ACUMED (Tytherington, UK) and was funded by Pfizer, Inc. This work was supported by a scientific research grant from Pfizer, Inc [grant number EXEAPO-0028-119].
Conflict of interest
Dr Hadji has received unrestricted educational grants, scientific research grants, and lecture fees from Pfizer, Inc. Dr Hasenburg has received honoraria for lectures from Pfizer, Inc. Dr Jones has received honoraria as a member of the speakers bureau for Pfizer, Inc. Dr Ziller has received support for travel to meetings for the study. Dr Menschik is a Pfizer employee and holds Pfizer stock. Dr Asmar, Dr van de Velde, Dr van Nes, Dr Nortier, and Mr Kuck have no conflicts of interest beyond elements of the Pfizer funding of the study noted in the Acknowledgements. The corresponding author had full access to all data and final responsibility for the decision to submit for publication.
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Hadji, P., Asmar, L., van Nes, J.G.H. et al. The effect of exemestane and tamoxifen on bone health within the Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial: a meta-analysis of the US, German, Netherlands, and Belgium sub-studies. J Cancer Res Clin Oncol 137, 1015–1025 (2011). https://doi.org/10.1007/s00432-010-0964-y
- Aromatase inhibitor
- Early breast cancer
- Bone mineral density