Abstract
BackgroundHormonal therapy is used as a treatment option in high-grade ovarian carcinoma (HGOC), but the role and choice of treatment remains unclear. Agents used include tamoxifen and aromatase inhibitors. Our aim was to evaluate the efficacy of tamoxifen (T) and letrozole (L) in HGOC in clinical practice and investigate factors influencing clinical outcome.MethodsA retrospective review of patients with relapsed HGOC treated with either tamoxifen or letrozole at the Royal Marsden Hospital between 2007 and 2012 was performed. The primary endpoint of the study was objective response rate (ORR). Secondary endpoints included CA125 response, clinical benefit rate (CBR) and duration of response. Platinum-sensitivity and ER-status were evaluated as predictors of treatment response.Results97 patients were included (43 T, 54 L); median age 63 years (20–92); 91% high-grade serous; median number of lines of prior chemotherapy 3 (1–8); 60% platinum-resistant, 40% platinum-sensitive; 52% ER + ve, 1% ER-ve, 47% unknown. 14 patients (6 T, 8 L) achieved a partial response, with ORR (RECIST) of 14% (T) and 15% (L). The CBR for ≥3 months was 65% (22/43) for tamoxifen and 56% (22/54) for letrozole. There was no significant difference in ORR (p = 0.99) or CBR (p = 0.14) between tamoxifen and letrozole. 22 patients (23%) had a CA-125 response with hormonal therapy (10 T – 23% and 12 L – 22%). ORR did not differ by platinum sensitivity (p = 0.42); or ER-status (positive vs unknown, p = 0.12). Responders to letrozole had longer durations of response than responders to tamoxifen (26 vs 11.5 months, p = 0.03), but equivalent disease stability duration (9.6 vs 7.2 months respectively, p = 0.11).ConclusionsWithin the constraints of a retrospective study, we identified that patients treated with letrozole had a significantly longer duration of response than those treated with tamoxifen. Treatment with either tamoxifen or letrozole is a rational treatment option for patients with ER + ve HGOC, with equivalent ORR, CBR and disease stability.
Highlights
Hormonal therapy is used as a treatment option in high-grade ovarian carcinoma (HGOC), but the role and choice of treatment remains unclear
There is a strong evidence base to support the use of hormonal therapy in the treatment of early and metastatic estrogen receptor (ER) -positive breast cancer, there are few prospective clinical trials evaluating this approach in recurrent ovarian cancer
Fortythree patients were treated with tamoxifen and 54 patients were treated with letrozole
Summary
Hormonal therapy is used as a treatment option in high-grade ovarian carcinoma (HGOC), but the role and choice of treatment remains unclear. Repeated courses of systemic chemotherapy may result in disease remission for many patients, but these episodes are typically characterized by progressively shorter progression-free intervals and often accumulating toxicity, highlighting the importance for better approaches to treating recurrent disease. Hormonal therapy (has been referred to as hormone therapy, endocrine therapy) is commonly used as a treatment option in patients with recurrent ovarian cancer who have exhausted or are not suitable for further standard lines of systemic chemotherapy. There is a strong evidence base to support the use of hormonal therapy in the treatment of early and metastatic estrogen receptor (ER) -positive breast cancer, there are few prospective clinical trials evaluating this approach in recurrent ovarian cancer
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