Adjuvant systemic therapy for male breast carcinoma

Abstract

In the current study, the authors describe the M. D. Anderson experience with adjuvant systemic therapy in male breast carcinoma patients. A total of 156 men with a diagnosis of breast carcinoma registered and were treated at the M. D. Anderson Cancer Center between 1944 and 2001. One hundred thirty-five men had nonmetastatic breast carcinoma at diagnosis and were included in this analysis. Patients' charts were retrospectively reviewed to obtain details of patient characteristics, adjuvant therapy, and outcomes. Analysis was performed with descriptive statistics; the log rank test was used to compare outcomes. The median patient age was 59 years (range, 25-80 yrs). Median follow-up was 13.8 years (range, 0.6-32.5 yrs). Sixty percent of patients had tumors 2 cm or smaller. Pathologic lymph node involvement was seen in 55% of patients. Tumors were estrogen receptor-positive in 85% of cases and progesterone receptor-positive in 71%. Chemotherapy was administered to 32 men (84% with adjuvant chemotherapy, 6% with neoadjuvant chemotherapy, and 9% with both). Approximately 81% received anthracycline-based regimens; 9% received additional taxanes; and 16% were treated with cyclophosphamide, methotrexate, and 5-fluorouracil (CMF). The median number of cycles was 6 (range, 4-14 cycles). Thirty-eight men received adjuvant hormonal therapy (92% received tamoxifen and 8% were treated with other therapy). The 5-year and 10-year overall survival rates were 86% and 75%, respectively, for men with lymph node-negative disease and 70% and 43%, respectively, for men with lymph node-positive disease. For men with lymph node-positive disease, adjuvant chemotherapy was associated with a lower risk of death (hazards ratio [HR] of 0.78), although this difference was not statistically significant. Overall survival was significantly better for men who received adjuvant hormonal therapy (HR of 0.45; P = 0.01). This relatively large series of men with breast carcinoma suggests that men benefit from adjuvant systemic therapy for breast carcinoma, with the greatest benefit from adjuvant hormonal therapy.