Cholesterol-Lowering Medication Improves Breast Cancer Outcomes

Women who initiate cholesterol-lowering medication during adjuvant endocrine therapy for breast cancer experience much better outcomes, according to new research.

Cholesterol-lowering medication (CLM) has been reported to play a role in preventing the recurrence of breast cancer, and may attenuate signaling through the estrogen receptor by reducing levels of the estrogenic cholesterol metabolite 27-hydroxycholesterol.
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For this study, a team including researchers from Lund University and Harvard Medical School analyzed findings from a randomized, phase III, double-blind trial conducted by the Breast International Group, which enrolled 8010 post-menopausal women with early-stage, hormone receptor-positive invasive breast cancer from 1998 to 2003.

The team measured systemic levels of total cholesterol and use of cholesterol-lowering medication at study entry, and again every 6 months for up to 5.5 years, and used cumulative incidence functions to describe the initiation of CLM in the presence of competing risks. Ultimately, they considered 3 time-to-event end points: disease-free survival (DSF), breast cancer-free interval, and distant recurrence-free interval.

The investigators found that cholesterol levels were reduced during tamoxifen therapy, and that the initiation of CLM during endocrine therapy was related to improved disease-free survival, breast cancer-free interval, and distant recurrence-free interval. Overall, the initiation of cholesterol-lowering therapy was linked to a 21% improvement in DSF, a 24% improvement in breast cancer-free interval, and a 26% improvement in distant recurrence-free interval, in comparison to women who received no cholesterol-targeted drugs.

"Cholesterol-lowering medication during adjuvant endocrine therapy may have a role in preventing breast cancer recurrence in hormone receptor-positive early-stage breast cancer," the authors wrote. "We recommend that these observational results be addressed in prospective randomized trials."

—Mark McGraw

References

Borgquist S, Giobbie-Hurder A, Ahern TP, et al. Cholesterol, cholesterol-lowering medication use, and breast cancer outcome in the BIG 1-98 Study [published online February 13, 2017]. J Clin Oncol. doi: 10.1200/JCO.2016.70.3116.