The alterations of serum FGF-21 levels, metabolic and body composition in early breast cancer patients receiving adjuvant endocrine therapy

Article type: Research Article

Authors: Akyol, Murat^a | Alacacioglu, Ahmet^{b; *} | Demir, Leyla^c | Kucukzeybek, Yuksel^b | Yildiz, Yasar^b | Gumus, Zehra^b | Kara, Mete^b | Salman, Tarik^b | Varol, Umut^b | Taskaynatan, Halil^b | Oflazoglu, Utku^b | Bayoglu, Vedat^b | Tarhan, Mustafa Oktay^d

Affiliations: [a] Department of Medical Oncology, Manisa State Hospital, Manisa, Turkey | [b] Department of Medical Oncology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey | [c] Department of Biochemistry, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey | [d] Institute of Oncology, Dokuz Eylul University, Izmir, Turkey

Correspondence: [*] Corresponding author: Ahmet Alacacioglu, Medical Oncology Clinic, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir 35360, Turkey. Tel.: +90 232 243 43 43; E-mail:dralaca2000@yahoo.com

Abstract: BACKGROUND: In early breast cancer patients, the effects of hormonal therapy (tamoxifen and aromatase inhibitors) on plasma fibroblast growth factor 21 (FGF-21), lipid levels and body composition have not yet been investigated. Therefore, we aimed to analyze the relationship between FGF-21 and body composition as well as the effects of tamoxifen and aromatase inhibitors on plasma lipid levels, FGF-21, and body composition. METHODS: A total of 72 patients were treated with either tamoxifen or aromatase inhibitors due to their menopausal status after adjuvant radiotherapy. Each patient was followed-up over a period of 1 year. Changes in body composition and serum lipid profile, glucose and FGF-21 levels were evaluated. We recorded the type of hormonal therapy, body mass index, waist-to-hip ratio, lipid profile, and FGF-21 levels both at the beginning and after 12 months. RESULTS: There was a statistically significant decrease in serum FGF-21 levels after 12 months of adjuvant endocrine therapy (46 ± 19.21 pg/ml vs. 30.99 ± 13.81 pg/ml, p< 0.001). Total body water (p< 0.001), serum glucose (p= 0.036) and triglyceride levels (p< 0.001) also exhibited a significant decrease. The decreases in total cholesterol and low-density lipoprotein were not statistically significant. Likewise, high-density lipoprotein increased after adjuvant endocrine therapy, although it did not reach statistical significance. The changes in body composition, glucose, lipid profile and FGF-21 were similar in tamoxifen and aromatase inhibitor groups. A positive correlation was found between basal weight, fat mass, fat-free mass and serum FGF-21 levels; however, the correlation was maintained only for the fat-free mass at the 12th month. CONCLUSION: As part of the present study, we suggest that both tamoxifen and aromatase inhibitors can reduce FGF-21 levels independently of body compositions, and these drugs can provide antihyperlipidemic, antidiabetic and cardio-protective effects. We also recommend that serum FGF-21 level can be utilized as a tumor biomarker in early-stage breast cancer and for monitoring purposes. FGF-21 levels may help physicians estimate prognosis, too. Further studies with larger populations may shed light on the role of FGF-21 in breast cancer.

Keywords: Breast cancer, serum FGF 21, glucose metabolism, lipid metabolism, tamoxifen, aromatase inhibitors

DOI: 10.3233/CBM-161507

Journal: Cancer Biomarkers, vol. 18, no. 4, pp. 441-449, 2017