Skip to main content

Advertisement

Log in

Weight change associated with anastrozole and tamoxifen treatment in postmenopausal women with or at high risk of developing breast cancer

Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Weight gain is commonly reported by breast cancer patients on tamoxifen or aromatase inhibitors. Since weight gain may impact on outcome and compliance we have prospectively assessed the effects of these agents on weight change in three randomised trials for the treatment or prevention of breast cancer. Data on weight change in postmenopausal women from three large clinical trials investigating endocrine therapy for the treatment or prevention of breast cancer were analysed (ATAC, IBIS-I and IBIS-II). In the IBIS-I study, mean weight change on tamoxifen was +0.1 kg (SD 0.1) compared with +0.3 kg (SD 0.1) in women taking the placebo (P = 0.3) between baseline and 12 months of follow-up. In the IBIS-II trial, no statistically significant difference was found between anastrozole and placebo after 12 months of follow-up [+0.8 kg (SD 5.3) vs. +0.5 kg (SD 7.4), P = 0.5]. In the ATAC trial, no statistically significant differences in weight gain between anastrozole and tamoxifen were found after 12 months of follow-up [+1.4 kg (SD 3.9) vs. +1.5 kg (SD 4.0), P = 0.4]. Significant baseline predictors for gaining more than 5 kg of weight after 12 months of follow-up were: being younger than 60 years old, smoking and mastectomy. All three trials demonstrate that weight gain occurs primarily within the first 12 months of active treatment in a subset of patients. In the prevention trials, weight gain does not differ between anastrozole, tamoxifen and placebo and also did not differ between anastrozole and tamoxifen in the treatment trial.

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

Access this article

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

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Tredan O, Bajard A, Meunier A, Roux P, Fiorletta I, Gargi T, Bachelot T, Guastalla JP, Lallemand Y, Faure C, Perol D, Bachmann P (2010) Body weight change in women receiving adjuvant chemotherapy for breast cancer: a French prospective study. Clin Nutr 29(2):187–191

    Google Scholar 

  2. Saquib N, Flatt SW, Natarajan L, Thomson CA, Bardwell WA, Caan B, Rock CL, Pierce JP (2007) Weight gain and recovery of pre-cancer weight after breast cancer treatments: evidence from the women’s healthy eating and living (WHEL) study. Breast Cancer Res Treat 105(2):177–186

    Article  PubMed  Google Scholar 

  3. Harvie MN, Campbell IT, Baildam A, Howell A (2004) Energy balance in early breast cancer patients receiving adjuvant chemotherapy. Breast Cancer Res Treat 83(3):201–210

    Article  PubMed  CAS  Google Scholar 

  4. Goodwin PJ, Ennis M, Pritchard KI, McCready D, Koo J, Sidlofsky S, Trudeau M, Hood N, Redwood S (1999) Adjuvant treatment and onset of menopause predict weight gain after breast cancer diagnosis. J Clin Oncol 17(1):120–129

    PubMed  CAS  Google Scholar 

  5. Irwin ML, McTiernan A, Baumgartner RN, Baumgartner KB, Bernstein L, Gilliland FD, Ballard-Barbash R (2005) Changes in body fat and weight after a breast cancer diagnosis: influence of demographic, prognostic, and lifestyle factors. J Clin Oncol 23(4):774–782

    Article  PubMed  Google Scholar 

  6. Monnin S, Schiller MR, Sachs L, Smith AM (1993) Nutritional concerns of women with breast cancer. J Cancer Educ 8(1):63–69

    Article  PubMed  CAS  Google Scholar 

  7. Carlini P, Bria E, Giannarelli D, Ferretti G, Felici A, Papaldo P, Fabi A, Nistico C, Di Cosimo S, Ruggeri EM, Milella M, Mottolese M, Terzoli E, Cognetti F (2005) New aromatase inhibitors as second-line endocrine therapy in postmenopausal patients with metastatic breast carcinoma: a pooled analysis of the randomized trials. Cancer 104(7):1335–1342

    Article  PubMed  CAS  Google Scholar 

  8. Sestak I, Distler W, Forbes JF, Dowsett M, Howell A, Cuzick J (2010) Effect of body mass index on recurrences in tamoxifen and anastrozole treated women: an exploratory analysis from the ATAC trial. J Clin Oncol 28(21):3411–3415

    Article  PubMed  CAS  Google Scholar 

  9. Pfeiler G, Konigsberg R, Fesl C, Mlineritsch B, Stoeger H, Singer CF, Postlberger S, Steger GG, Seifert M, Dubsky P, Taucher S, Samonigg H, Bjelic-Radisic V, Greil R, Marth C, Gnant M (2010) Impact of body mass index on the efficacy of endocrine therapy in premenopausal patients with breast cancer: an analysis of the prospective ABCSG-12 trial. J Clin Oncol 29(19): 2653–2659

    Google Scholar 

  10. Kroenke CH, Chen WY, Rosner B, Holmes MD (2005) Weight, weight gain, and survival after breast cancer diagnosis. J Clin Oncol 23(7):1370–1378

    Article  PubMed  Google Scholar 

  11. Caan BJ, Kwan ML, Hartzell G, Castillo A, Slattery ML, Sternfeld B, Weltzien E (2008) Pre-diagnosis body mass index, post-diagnosis weight change, and prognosis among women with early stage breast cancer. Cancer Causes Control 19(10):1319–1328

    Article  PubMed  Google Scholar 

  12. Goodwin PJ, Panzarella T, Boyd NF (1988) Weight gain in women with localized breast cancer—a descriptive study. Breast Cancer Res Treat 11(1):59–66

    Article  PubMed  CAS  Google Scholar 

  13. Carmichael AR (2006) Obesity and prognosis of breast cancer. Obes Rev 7(4):333–340

    Article  PubMed  CAS  Google Scholar 

  14. Nichols HB, Trentham-Dietz A, Egan KM, Titus-Ernstoff L, Holmes MD, Bersch AJ, Holick CN, Hampton JM, Stampfer MJ, Willett WC, Newcomb PA (2009) Body mass index before and after breast cancer diagnosis: associations with all-cause, breast cancer, and cardiovascular disease mortality. Cancer Epidemiol Biomarkers Prev 18(5):1403–1409

    Article  PubMed  Google Scholar 

  15. Hoskin PJ, Ashley S, Yarnold JR (1992) Weight gain after primary surgery for breast cancer—effect of tamoxifen. Breast Cancer Res Treat 22(2):129–132

    Article  PubMed  CAS  Google Scholar 

  16. Kumar NB, Allen K, Cantor A, Cox CE, Greenberg H, Shah S, Lyman GH (1997) Weight gain associated with adjuvant tamoxifen therapy in stage I and II breast cancer: fact or artifact? Breast Cancer Res Treat 44(2):135–143

    Article  PubMed  CAS  Google Scholar 

  17. Fisher B, Dignam J, Bryant J, DeCillis A, Wickerham DL, Wolmark N, Costantino J, Redmond C, Fisher ER, Bowman DM, Deschenes L, Dimitrov NV, Margolese RG, Robidoux A, Shibata H, Terz J, Paterson AH, Feldman MI, Farrar W, Evans J, Lickley HL (1996) Five versus more than five years of tamoxifen therapy for breast cancer patients with negative lymph nodes and estrogen receptor-positive tumors. J Natl Cancer Inst 88(21):1529–1542

    Article  PubMed  CAS  Google Scholar 

  18. Day R, Ganz PA, Costantino JP, Cronin WM, Wickerham DL, Fisher B (1999) Health-related quality of life and tamoxifen in breast cancer prevention: a report from the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Clin Oncol 17(9):2659–2669

    PubMed  CAS  Google Scholar 

  19. Powles T, Eeles R, Ashley S, Easton D, Chang J, Dowsett M, Tidy A, Viggers J, Davey J (1998) Interim analysis of the incidence of breast cancer in the Royal Marsden Hospital tamoxifen randomised chemoprevention trial. Lancet 352(9122):98–101

    Article  PubMed  CAS  Google Scholar 

  20. Baum M, Buzdar A, Cuzick J, Forbes J, Houghton J, Howell A, Sahmoud T (2003) Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early-stage breast cancer: results of the ATAC (Arimidex, Tamoxifen Alone or in Combination) trial efficacy and safety update analyses. Cancer 98(9):1802–1810

    Article  PubMed  CAS  Google Scholar 

  21. Francini G, Petrioli R, Montagnani A, Cadirni A, Campagna S, Francini E, Gonnelli S (2006) Exemestane after tamoxifen as adjuvant hormonal therapy in postmenopausal women with breast cancer: effects on body composition and lipids. Br J Cancer 95(2):153–158

    Article  PubMed  CAS  Google Scholar 

  22. Cuzick J (2008) IBIS II: a breast cancer prevention trial in postmenopausal women using the aromatase inhibitor anastrozole. Expert Rev Anticancer Ther 8(9):1377–1385

    Article  PubMed  CAS  Google Scholar 

  23. Cuzick J (2008) Chemoprevention of breast cancer. Breast Cancer 15(1):10–16

    Article  PubMed  Google Scholar 

  24. Fallowfield L (2008) There’s many a slip twixt cup and lip: adherence issues in cancer therapy. Nat Clin Pract Oncol 5(3):118–119

    Article  PubMed  Google Scholar 

  25. Vrieling A, Buck K, Kaaks R, Chang-Claude J (2010) Adult weight gain in relation to breast cancer risk by estrogen and progesterone receptor status: a meta-analysis. Breast Cancer Res Treat 123(3):641–649

    Google Scholar 

  26. Vance V, Mourtzakis M, McCargar L, Hanning R (2010) Weight gain in breast cancer survivors: prevalence, pattern and health consequences. Obes Rev 12(4): 282–294

    Google Scholar 

  27. Cuzick J, Forbes J, Edwards R, Baum M, Cawthorn S, Coates A, Hamed A, Howell A, Powles T (2002) First results from the International Breast Cancer Intervention Study (IBIS-I): a randomised prevention trial. Lancet 360(9336):817–824

    Article  PubMed  CAS  Google Scholar 

  28. Baum M, Budzar AU, Cuzick J, Forbes J, Houghton JH, Klijn JG, Sahmoud T (2002) Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer: first results of the ATAC randomised trial. Lancet 359(9324):2131–2139

    Article  PubMed  CAS  Google Scholar 

  29. Forbes JF, Cuzick J, Buzdar A, Howell A, Tobias JS, Baum M (2008) Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 100-month analysis of the ATAC trial. Lancet Oncol 9(1):45–53

    Article  PubMed  Google Scholar 

  30. Howell A, Cuzick J, Baum M, Buzdar A, Dowsett M, Forbes JF, Hoctin-Boes G, Houghton J, Locker GY, Tobias JS (2005) Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years’ adjuvant treatment for breast cancer. Lancet 365(9453):60–62

    Article  PubMed  CAS  Google Scholar 

  31. Powles TJ, Ashley S, Tidy VA, Smith IE, Dowsett M (2006) 20 year follow-up of the Royal Marsden tamoxifen breast cancer prevention trials. In: San Antonio Breast Cancer Symposium. San Antonio

  32. Levine EG, Raczynski JM, Carpenter JT (1991) Weight gain with breast cancer adjuvant treatment. Cancer 67(7):1954–1959

    Article  PubMed  CAS  Google Scholar 

  33. Goodwin P, Esplen MJ, Butler K, Winocur J, Pritchard K, Brazel S, Gao J, Miller A (1998) Multidisciplinary weight management in locoregional breast cancer: results of a phase II study. Breast Cancer Res Treat 48(1):53–64

    Article  PubMed  CAS  Google Scholar 

  34. Knobf MT (1986) Physical and psychologic distress associated with adjuvant chemotherapy in women with breast cancer. J Clin Oncol 4(5):678–684

    PubMed  CAS  Google Scholar 

  35. DeGeorge D, Gray JJ, Fetting JH, Rolls BJ (1990) Weight gain in patients with breast cancer receiving adjuvant treatment as a function of restraint, disinhibition, and hunger. Oncol Nurs Forum 17(3 Suppl):23–28 discussion 28-30

    PubMed  CAS  Google Scholar 

  36. Winningham ML, Nail LM, Burke MB, Brophy L, Cimprich B, Jones LS, Pickard-Holley S, Rhodes V, St Pierre B, Beck S et al (1994) Fatigue and the cancer experience: the state of the knowledge. Oncol Nurs Forum 21(1):23–36

    PubMed  CAS  Google Scholar 

  37. Svendsen OL, Hassager C, Christiansen C (1995) Age- and menopause-associated variations in body composition and fat distribution in healthy women as measured by dual-energy X-ray absorptiometry. Metabolism 44(3):369–373

    Article  PubMed  CAS  Google Scholar 

  38. Wing RR (1992) Obesity and weight gain during adulthood: a health problem for United States women. Womens Health Issues 2(2):114–120 discussion 120-2

    Article  PubMed  CAS  Google Scholar 

  39. Wing RR, Matthews KA, Kuller LH, Meilahn EN, Plantinga PL (1991) Weight gain at the time of menopause. Arch Intern Med 151(1):97–102

    Article  PubMed  CAS  Google Scholar 

  40. Beaver ME, Matheny KE, Roberts DB, Myers JN (2001) Predictors of weight loss during radiation therapy. Otolaryngol Head Neck Surg 125(6):645–648

    Article  PubMed  CAS  Google Scholar 

  41. Nourissat A, Bairati I, Samson E, Fortin A, Gelinas M, Nabid A, Brochet F, Tetu B, Meyer F (2010) Predictors of weight loss during radiotherapy in patients with stage I or II head and neck cancer. Cancer 116(9):2275–2283

    Google Scholar 

  42. Langius JA, Doornaert P, Spreeuwenberg MD, Langendijk JA, Leemans CR, Schueren MA (2010) Radiotherapy on the neck nodes predicts severe weight loss in patients with early stage laryngeal cancer. Radiother Oncol 97(1):80–85

    Google Scholar 

  43. Kulkarni SK, Kaur G (2001) Pharmacodynamics of drug-induced weight gain. Drugs Today (Barc) 37(8):559–571

    Article  CAS  Google Scholar 

  44. Hauber AB, Mohamed AF, Johnson FR, Falvey H (2009) Treatment preferences and medication adherence of people with Type 2 diabetes using oral glucose-lowering agents. Diabet Med 26(4):416–424

    Article  PubMed  CAS  Google Scholar 

  45. Harvie M, Howell T (2005) Need for weight management among postmenopausal early breast cancer patients receiving adjuvant endocrine therapy. Womens Health (Lond Engl) 1(2):205–222

    Article  Google Scholar 

Download references

Acknowledgments

This analysis was supported by the Cancer Research UK and AstraZeneca.

Conflict of interest

Ivana Sestak, Michelle Harvie and Anthony Howell have no conflict of interest to declare. Jack Cuzick received research funding from AstraZeneca. John F. Forbes received honoraria from AstraZeneca and Novartis. Mitch Dowsett received consultancy fees, honoraria, research funding and expert testimony from AstraZeneca.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ivana Sestak.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sestak, I., Harvie, M., Howell, A. et al. Weight change associated with anastrozole and tamoxifen treatment in postmenopausal women with or at high risk of developing breast cancer. Breast Cancer Res Treat 134, 727–734 (2012). https://doi.org/10.1007/s10549-012-2085-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-012-2085-6

Keywords

Navigation