Abstract
We have used primary endocrine therapy for 61 elderly women with operable breast cancer (median age 77 years). Eleven patients (18%) had complete and 24 (39%) partial tumour regression, 12 (20%) had stable disease for a minimum of six months and 14 (23%) no response. Salvage surgery was undertaken in the 14 with no response and 8/9 with progressive disease following initial response, thus samples were available from relapse patients only. Assays for EGFr (two point radioreceptor assay) and oestrogen receptors (ER) (dextran coated charcoal method and an immunohistochemical method) were performed on 20/22 patients. Ten of these 20 tumours were EGFr+ (greater than 10 fmol mg-1 binding) and 9/13 patients progressing within six months had EGFr+ tumours. 15/22 were available for ER evaluation and there was no such association with ER status. EGFr status was also associated with early recurrence after surgery and death in the endocrine failure group (P less than 0.005 and P less than 0.05 respectively). Of a control population of 33 patients (median age 72 years) treated by primary surgery, only 6 were EGFr+. In this group early relapse was predicted by EGFr status, but not by ER status (median disease free survival for EGFr+ patients 15 months, and for EGFr- patients 40 months, P less than 0.01, logrank test). There was a significantly higher proportion of EGFr+ tumours in the endocrine failure group compared with the control population (P less than 0.001). EGFr status is a marker for rapid early progression on primary endocrine therapy and the development of non-excisional methods of EGFr analysis would allow better directed therapeutic decisions.
Highlights
Of sixty-one patients commenced on primary endocrine therapy eleven achieved a complete response (CR), twentyfour a partial response (PR), twelve had static disease (SD)
There was no significant difference in recurrence free survival (RFS) measured from the start of therapy between the primary endocrine and primary surgical therapy groups (Figure la)
We have evaluated the interaction of Epidermal growth factor receptor (EGFr) and ER in relation to failure of response to hormone therapy
Summary
Fifty-one patients over seventy years and ten in their late sixties with severe intercurrent medical illness or severe psychological aversion to mastectomy who were otherwise considered to have primary operable breast cancer were offered primary endocrine therapy. Patients with proven distant metastases at the time of presentation, as assessed by biochemical and clinical criteria, were excluded from this study. The median age was 77 years (range 64-96) and all patients were over 15 years postmenopausal. All the patients had confirmation of the diagnosis by fine needle aspiration biopsy. Primary endocrine therapy with either tamoxifen (20mg once daily) (60 patients) or low dose aminoglutethimide (125mg twice daily) and hydrocortisone (20mg twice daily) was used. Three patients received low dose aminoglutethimide, one as primary therapy and two who had rapidly progressed on tamoxifen
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