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Falsely elevated serum oestradiol due to exemestane therapy
Sanja Mandic1,2, Jϋrgen Kratzsch3, Dario Mandic1,2
11 Institute of Clinical Laboratory Diagnostics, Osijek University Hospital, Osijek, Croatia.
Annals of Clinical Biochemistry
|October 1, 2016
Summary
Immunoassays can falsely elevate oestradiol (E2) levels in breast cancer patients on exemestane therapy. Liquid chromatography tandem mass spectrometry confirmed undetectable E2, highlighting potential for incorrect treatment decisions.
Area of Science:
- Endocrinology
- Clinical Chemistry
- Pharmacology
Background:
- Exemestane is a steroidal aromatase inhibitor used in breast cancer treatment.
- Monitoring oestradiol (E2) levels is crucial for assessing treatment efficacy.
- Immunoassays are common methods for measuring hormone concentrations in clinical settings.
Observation:
- A breast cancer patient on exemestane therapy presented with falsely elevated oestradiol (E2) levels.
- Two different immunoassays consistently reported high E2 concentrations.
- Liquid chromatography tandem mass spectrometry (LC-MS/MS) revealed undetectable E2 levels.
Findings:
- The discrepancy between immunoassay and LC-MS/MS results suggests assay interference.
- Structural similarity between exemestane and E2 is the likely cause of the positive bias.
- Immunochemical E2 measurements were unreliable in this patient receiving exemestane.
Implications:
- Inaccurate E2 measurements can lead to misinterpretation of treatment response.
- Potential for unnecessary and harmful changes in breast cancer therapy.
- Highlights the importance of assay validation and orthogonal testing in specific clinical scenarios.
