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Insulin-like growth factor 1 and musculoskeletal pain among breast cancer patients on aromatase inhibitor therapy and women without a history of cancer

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Abstract

Purpose

Musculoskeletal pain is a common side effect of aromatase inhibitors (AIs), the adjuvant hormonal treatment of choice for postmenopausal estrogen-receptor-positive breast cancer. Although the pain is usually attributed to the estrogen depletion associated with AIs, not all women on AIs experience these symptoms. Thus, the goal of this study was to examine whether changes in the insulin-like growth factor (IGF) axis were associated with pain among women initiating AI therapy or a comparison group of women without a history of cancer.

Methods

Data were analyzed from a cohort study of 52 breast cancer patients for whom AI therapy was planned and 88 women without a history of cancer. Questionnaire data on pain symptoms were collected, and blood was drawn at baseline (prior to AI therapy for patients) and 6 months after baseline. The blood samples were assayed for IGF-1 and IGF-binding protein-3 (IGFBP-3).

Results

While results showed no statistically significant changes in any of the measures across time for either the breast cancer or the comparison group, increases in both IGF-1 concentrations and the IGF-1/IGFBP-3 ratio over the first 6 months of AI treatment were significantly associated with the onset or increase in musculoskeletal pain among the breast cancer patients. Associations between IGF-1, IGFBP-3, and the IGF-1/IGFBP-3 ratio and pain were not observed in the comparison group.

Conclusions

Although preliminary, findings from this study implicate the IGF axis in the development of AI-associated musculoskeletal pain and represent a first step in developing effective interventions to alleviate this side effect.

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Acknowledgments

The work was supported by grants from the National Cancer Institute (R03 CA132147), AstraZeneca (IRUSANAS0073), and the Susan G. Komen for the Cure Foundation (POP0601174). Dr. Gallicchio is supported, in part, by a Career Catalyst Research Grant from Susan G. Komen for the Cure Foundation (KG110356).

Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. The Prevention and Research Center, The Weinberg Center for Women’s Health and Medicine, Mercy Medical Center, 227 St. Paul Place, 6th Floor, Baltimore, MD, 21202, USA

    Lisa Gallicchio, Ryan MacDonald & Kathy J. Helzlsouer

  2. Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA

    Lisa Gallicchio & Kathy J. Helzlsouer

  3. Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, USA

    Lisa Gallicchio

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  1. Lisa Gallicchio
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  2. Ryan MacDonald
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  3. Kathy J. Helzlsouer
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Correspondence to Lisa Gallicchio.

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Gallicchio, L., MacDonald, R. & Helzlsouer, K.J. Insulin-like growth factor 1 and musculoskeletal pain among breast cancer patients on aromatase inhibitor therapy and women without a history of cancer. J Cancer Res Clin Oncol 139, 837–843 (2013). https://doi.org/10.1007/s00432-013-1391-7

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  • DOI: https://doi.org/10.1007/s00432-013-1391-7

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