Idoxifene antagonizes estradiol-dependent MCF-7 breast cancer xenograft growth through sustained induction of apoptosis

Idoxifene is a novel selective estrogen (E2) receptor (ER) modulator that I s currently in clinical development for the treatment of breast cancer, Com pared to tamoxifen, idoxifene is metabolically more stable, with a higher r elative binding affinity for the ER and reduced agonist activity on breast and uterine cells, Idoxifene also inhibits calmodulin, a calcium-binding pr otein that is involved in cell signal transduction pathways, In this study, the abilities of idoxifene and tamoxifen to antagonize E2-de pendent MCF-7 xenograft growth in oophorectomized athymic mice were compare d, The basis for idoxifene's antitumor activity was examined by comparing t he effectiveness of the clinically used transisomer (referred to here as id oxifene) with its cis-isomer, which has a 50-fold lower relative binding af finity for ER than idoxifene but similar calmodulin-inhibitory activity. Ch anges in tumor cell proliferation, apoptosis, and ER-dependent protein expr ession were studied. Both idoxifene and tamoxifen significantly inhibited E 2-dependent tumor growth, whereas cis-idoxifene had little effect. Withdraw al of E2 support induced significant tumor regression due to impaired cell proliferation (Ki-67 score, 9 versus 51% compared to E2 controls) and induc tion of apoptosis (3.6 versus 0.9% compared to E2 controls). Both anti-E2s inhibited cell proliferation and caused a significant 3-fold induction of a poptosis in E2 sopported tumors after 1 week, which was maintained for 3 mo nths with idoxifene (3.1 versus 0.48% compared to E2 controls) but decrease d back to baseline in tumors treated with tamoxifen (0.69%), In contrast, c is-idoxifene had no effect on either cell proliferation or apoptosis, Both tamoxifen and idoxifene initially induced ER expression, whereas prolonged therapy with tamoxifen significantly reduced progesterone receptor levels, In conclusion, idoxifene resulted in similar inhibition of E2-dependent MCF -7 xenograft growth compared with tamoxifen, an effect that is mediated via ER rather than through calmodulin. Sustained induction of apoptosis may co ntribute to prolonged antagonism of E2-dependent growth, and it occurred to a greater extent following 3 months of idoxifene, compared to tamoxifen.