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pattypoo54

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Posts: 47
Reply with quote  #1 
Hello Edge,
I have mild osteopenia and my doctor says she might recommend evista for me as a bone building drug.I am having a follow up dexa scan next thursday. I am triple negative and almost five years out Dec 15. She says it is a good bone building drug, and also might help prevent a reocurrence of er positive breast cancer. What do you think?
Thanks 
Patty
edge

Chief of Research
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Reply with quote  #2 

Patty:

 

Although the SERM (selective estrogen receptor modulator) raloxifene (Evista) displays, in the presence of physiological amounts of estradiol, a powerful inhibitory effect on estrogen-promoted cell migration and invasion as recently confirmed by Tommaso Simoncini and colleagues at the University of Pisa, I should note that this role as an ER antagonist in the presence of estradiol has been only on ER-positive breast cancer cells.  I am unaware of any appreciable data of activity in triple negative tumors and would not anticipate such from its underlying effects on cell cytoskeletal remodeling and motility. 

 

Given that, raloxifene (Evista) may indeed prove valuable against local progression and distant metastasis of estrogen-promoted cell migration and invasion, although this is still at the preclinical stage of evidence, but in contrast the bisphosphonates as a class, especially but not exclusively zoledronic acid (Zometa) and clodronate (Bonefos, out side the U.S.) have increasingly robust human clinical evidence of anti-bone-metastatic activity independent of the estrogen context, and to my mind as I have documented elsewhere, something more, namely that there is also suggestive evidence of an antiangiogenic activity (like the anti-VEGF activity of bevacizumab (Avastin)).  Therefore, in comparison to bisphosphonates, the potential anti-metastatic benefit, if any, of the SERM  raloxifene (Evista) in non-estrogen-driven classes of breast cancer such as TNBC, is narrowly circumscribed and likely to be highly limited to just those contexts in which receptor shift (to endocrine-responsive) is in effect, something you should discuss further with your oncologist, and in sum I would on the basis of the above favor a (receptor-neutral) bisphosphonate instead.

 


Constantine Kaniklidis
Breast Cancer Watch
edge@evidencewatch.com

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