Skip to main content
SpringerLink
Log in

Sequential Changes in Serum Triglyceride Levels During Adjuvant Tamoxifen Therapy in Breast Cancer Patients and the Effect of Dose Reduction

  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Tamoxifen (TAM) and estrogen increase serum triglyceride (TG) levels, sometimes inducing severe hypertriglyceridemia and possibly contributing to death. Decreasing the dose of estrogen in estrogen replacement therapy may minimize its adverse effects, including the hypertriglyceridemia. The serum TG, total cholesterol, low-density-lipoprotein (LDL) cholesterol and high-density-lipoprotein (HDL) cholesterol were measured periodically in 116 breast cancer patients on adjuvant TAM therapy at a dose of 10 mg twice daily. The serum TG level was significantly increased 15 months after treatment, but the magnitude of increase was clinically insignificant in most patients (n = 102). If TG levels rose above 400 mg/dl, the dose of TAM was reduced to 10 mg once daily (n = 14). The TG was lowered to a safer level after the dose reduction of TAM in 10 of 14 patients. The other four patients had early onset hypertriglyceridemia after beginning TAM (within 6 months), and their TG levels did not decrease satisfactorily after dose reduction. Hence, they required antilipemic medication with or without discontinuing TAM. This study suggests that reducing TAM from 10 mg twice daily to 10 mg once daily decreases the marked hypertriglyceridemia that occurs in some patients during TAM treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Coezy E, Borgna JL, Rochefort H: Tamoxifen and metabolites in MCF7 cells: correlation between binding to estrogen receptor and inhibition of cell growth. Cancer Res 42: 317–323, 1982

    Google Scholar 

  2. Sutherland RL, Watts CKW, Hall RE, Ruenitz PC: Mechanisms of growth inhibition by nonsteroidal antiestrogens in human breast cancer cells. J Steroid Biochem 27: 891–897, 1987

    Google Scholar 

  3. Robinson E, Kimmick GG, Muss HB: Tamoxifen in postmenopausal women: a safety perspective. Drugs Aging 8: 329–337, 1996

    Google Scholar 

  4. Early Breast Cancer Trialists' Collaborative Group: Tamoxifen for early breast cancer: an overview of the randomized trials. Lancet 351: 1451–1467, 1998

    Google Scholar 

  5. Decensi A, Bonanni B, Guerrieri-Gonzaga A, Gandini S, Robertson C, Johansson H, Travaglini R, Sandri MT, Tessadrelli A, Farante G, Salinaro F, Bettega D, Barreca A, Boyle P, Costa A, Veronesi U: Biologic activity of tamoxifen at low doses in healthy women. J Natl Cancer Inst 90: 1461–1467, 1998

    Google Scholar 

  6. Pavlidis NA, Petris C, Briassoulis E, Klouvas G, Psilas C, Rempapis J, Petroutsos G: Clear evidence that long-term, low-dose tamoxifen treatment can induce ocular toxicity: a prospective study of 63 patients. Cancer 69: 2961–2964, 1992

    Google Scholar 

  7. Wogan GN: Review of toxicology of tamoxifen. Semin Oncol 24(Suppl 1): S1-87–S1-97, 1997

    Google Scholar 

  8. Bruning PF, Bonfrer JMG, Hart AAM, de Jong-Bakker M, Linders D, van Loon J, Nooyen WJ: Tamoxifen, serum lipoproteins and cardiovascular risk. Br J Cancer 58: 497–499, 1988

    Google Scholar 

  9. Bagdade JD, Wolter J, Subbaiah PV, Ryan W: Effects of tamoxifen treatment on plasma lipids and lipoprotein lipid composition. J Clin Endocrinol Metab 70: 1132–1135, 1990

    Google Scholar 

  10. Love RR, Wiebe DA, Newcomb PA, Cameron L, Leventhal H, Jordan VC, Feyzi J, DeMets DL: Effects of tamoxifen on cardiovascular risk factors in postmenopausal women. Ann Int Med 115: 860–864, 1991

    Google Scholar 

  11. Hozumi Y, Kawano M, Saito T, Miyata M: Effect of tamoxifen on serum lipid metabolism. J Clin Endocrinol Metab 83: 1633–1635, 1998

    Google Scholar 

  12. Brun LD, Gagne C, Rousseau C, Moorjani S, Lupien PJ: Severe lipemia induced by tamoxifen. Cancer 57: 2123–2126, 1986

    Google Scholar 

  13. Noguchi M, Taniya T, Tajiri K, Miwa K, Miyazaki I, Koshino H, Mabuchi H, Nonomura A: Fatal hyperlipaemia in a case of metastatic breast cancer treated by tamoxifen. Br J Surg 74: 586–587, 1987

    Google Scholar 

  14. Elisaf MS, Nakou K, Liamis G, Pavlidis NA: Tamoxifeninduced severe hypertriglyceridemia and pancreatitis. Ann Oncol 11: 1067–1069, 2000

    Google Scholar 

  15. Fisher B, Costantino JP, Redmond CK, Fisher ER, Wickerham DL, Cronin WM, Other NSABP Contributors: Endometrial cancer in tamoxifen-treated breast cancer patients: findings from the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-14. J Natl Cancer Inst 86: 527–537, 1994

    Google Scholar 

  16. Rutqvist LE, Johansson H, Signomklao T, Johansson U, Fornander T, Wilking N: Adjuvant tamoxifen therapy for early stage breast cancer and second primary malignancies. J Natl Cancer Inst 87: 645–651, 1995

    Google Scholar 

  17. Walsh BW, Schiff I, Rosner B, Greenberg L, Ravnikar V, Sacks FM: Effects of postmenopausal estrogen replacement on the concentrations and metabolism of plasma lipoproteins. N Engl J Med 325: 1196–1204, 1991

    Google Scholar 

  18. Bertelli G, Pronzato P, Amoroso D, Cusimano MP, Conte PF, Montagna G, Bertolini S, Rosso R: Adjuvant tamoxifen in primary breast cancer: influence on plasma lipids and antithrombin III levels. Breast Cancer Res Treat 12: 307–310, 1988

    Google Scholar 

  19. Gylling H, Pyrhonen S, Mantyla E, Maenpaa H, Kangas L, Miettinen TA: Tamoxifen and toremifene lower serum cholesterol by inhibition of Δ8-cholesterol conversion to lathosterol in women with breast cancer. J Clin Oncol 13: 2900–2905, 1995

    Google Scholar 

  20. Rader DJ, Rosas S: Management of selected lipid abnormalities: hypertriglyceridemia, low HDL cholesterol, lipoprotein(a) in thyroid and renal diseases and post-transplantation. Med Clin North Am 84: 43–61, 2000

    Google Scholar 

  21. Council on Scientific Affairs: Management of disorders of cholesterol, triglyceride, and lipoprotein metabolism: report 6 of the Council on Scientific Affairs. Arch Fam Med 4: 869–878, 1995

    Google Scholar 

  22. Decensi A, Gandini S, Guerrieri-Gonzaga A, Johansson H, Manetti L, Bonanni B, Sandri MT, Barreca A, Costa A, Robertson C, Lien EA: Effect of blood tamoxifen concentrations on surrogate biomarkers in a trial of dose reduction in healthy women. J Clin Oncol 17: 2633–2638, 1999

    Google Scholar 

  23. Bernardes JRM, Nonogaki S, Seixas MT, de Lima GR, Baracat EC, Gebrim LH: Effect of a half dose of tamoxifen on proliferative activity in normal breast tissue. Int J Gynecol Obstet 67: 33–38, 1999

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, Mackay Memorial Hospital, Taipei, Taiwan

    Chien-Liang Liu & Tsen-Long Yang

Authors
  1. Chien-Liang Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tsen-Long Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Liu, CL., Yang, TL. Sequential Changes in Serum Triglyceride Levels During Adjuvant Tamoxifen Therapy in Breast Cancer Patients and the Effect of Dose Reduction. Breast Cancer Res Treat 79, 11–16 (2003). https://doi.org/10.1023/A:1023348021773

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1023348021773

Search

Navigation