Adjuvant ovarian ablation vs CMF chemotherapy in premenopausal breast cancer patients: trial update and impact of immunohistochemical assessment of ER status

Thomson, Catherine S.; Twelves, Chris; Mallon, Elizabeth; Leake, Robin

doi:10.1054/brst.2002.0451

Cited by 47 publications

(26 citation statements)

References 8 publications

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“…197 Studies in premenopausal women of ovarian ablation or suppression alone versus CMF chemotherapy alone generally demonstrate similar antitumor efficacy in patients with hormone receptor-positive tumors, and superior outcomes with CMF in patients with hormone receptor-negative tumors. [197][198][199][200][201][202][203][204][205] Findings also suggest that the benefits of ovarian suppression/ablation may be greater in the younger premenopausal group. Studies of ovarian ablation/ suppression plus tamoxifen versus chemotherapy alone in premenopausal women generally demonstrate no difference in rates of recurrence or survival between the treatments.…”

Section: Adjuvant Endocrine Therapymentioning

confidence: 99%

Breast Cancer Version 3.2014

Gradishar¹,

Anderson²,

Blair³

et al. 2014

J Natl Compr Canc Netw

175

117

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Section: Adjuvant Endocrine Therapymentioning

confidence: 99%

Breast Cancer Version 3.2014

Gradishar¹,

Anderson²,

Blair³

et al. 2014

J Natl Compr Canc Netw

175

117

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“…In this trial a switching strategy from letrozole to tamoxifen or vice versa was also evaluated. Initial reports revealed that treatment with letrozole significantly improved disease-free survival (HR 0.81, P ¼ 0.003) after a median follow-up of 2 years (Thurliman et al, 2005). Side effects were similar to those described with anastrazole.…”

Section: Treatment Of Postmenopausal Women: Aromatase Inhibitorsmentioning

confidence: 66%

“…Thus it was postulated that adjuvant chemotherapy might actually function via ovarian suppression. In the studies that examined ovarian suppression alone compared to chemotherapy alone, the outcomes were similar and there was not a clear superiority for either strategy (Kaufmann et al, 2003(Kaufmann et al, , 2007Ejlertsen et al, 2006;Thomson et al, 2002;Schmid et al, 2007;IBCSG, 2003;von Minckwitz et al, 2006;Jonat et al, 2002). The only clear advantage to CMF chemotherapy over ovarian suppression is in hormone receptor-negative cases (Kaufmann et al, 2003).…”

Section: Ovarian Suppressionmentioning

confidence: 99%

Hormonal therapy in breast cancer: A model disease for the personalization of cancer care

2012

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Keywords:Breast cancer Endocrine therapy Prognostic assays Estrogen receptor Tamoxifen Aromatase inhibitors A B S T R A C TThe treatment of breast cancer is driven by subtype classification, of which the assessment of hormone receptor status is one of the important determinants of therapy. The use of hormonal therapy to treat estrogen-receptor positive breast cancer has been studied for over a century and is one of the well-described uses of personalized medicine. In this review, we will describe the classification of hormone receptor status and the various endocrine treatment strategies. Opportunities for personalization of care are illustrated.ª 2012 Federation of European Biochemical Societies.Published by Elsevier B.V. All rights reserved. IntroductionThe molecular diversity observed in breast cancer clearly illustrates the need for personalized medicine in the treatment of this disease. Breast cancer is one of the prototype cancers for which there is an abundance of data to support the categorization of subtypes with subsequent directed therapy toward those unique characteristics. In fact, the use of hormonal therapy for breast cancer is an example of one of the earliest uses of targeted therapy for cancer. At the turn of the last century, a Scottish physician, Sir George Beatson reported three women with advanced breast cancer where oophorectomy led to regression of mammary tumors (Beatson, 1896). With this landmark observation, the idea of using hormonal manipulation to treat cancer was initiated. Later trials were able to demonstrate that sensitivity to hormonal manipulation was only seen in tumors that expressed the estrogen-receptor alpha (ER) (De Sombre et al., 1974

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“…A number of studies have shown a direct linear relationship between er concentration and survival 3,8,14,16,18,[23][24][25][26] . However, very few studies have supported the use of antihormonal treatment in breast cancer patients whose tumours are weakly positive for er (3-9 fmol/mg cytosol protein by lba or 1%-9% by ihc assay).…”

Section: Discussionmentioning

confidence: 99%

“…However, very few studies have supported the use of antihormonal treatment in breast cancer patients whose tumours are weakly positive for er (3-9 fmol/mg cytosol protein by lba or 1%-9% by ihc assay). The six studies used to establish the guidelines published by the American Society of Clinical Oncology and the College of American Pathologists had different scoring systems, different threshold values, limited follow-up, and a low number of patients with er-poor tumours 8,16,18,23,24,27 . Recently, the Early Breast Cancer Trialists' Collaborative Group published a meta-analysis studying the relevance of breast cancer hormone receptors and the efficacy of adjuvant tamoxifen 10 .…”

Section: Discussionmentioning

confidence: 99%

Prognostic and Predictive Value of Low Estrogen Receptor Expression in Breast Cancer

et al. 2017

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Purpose Anti-hormonal therapy (tamoxifen) is recommended for estrogen receptor (er)-positive breast cancer (bca); however, its effect on low-receptor cancers is unclear. We retrospectively evaluated the effect of adjuvant tamoxifen in patients with weakly er-positive bca. MethodsWe identified 2221 bca patients who had been er-tested by ligand-based assay (lba) during [1976][1977][1978][1979][1980][1981][1982][1983][1984][1985][1986][1987][1988][1989][1990][1991][1992][1993][1994][1995] and who had been treated and followed until 2008. Cox proportional hazards models adjusted for age, body mass index, tumour size, nodal status, surgery, and chemotherapy were used to assess the effect of er level on bca survival in patients who received tamoxifen.Results Overall, 17% (383) of patients were within 0-3 fmol/mg cytosol protein, and 12% (266) were within 4-9 fmol/mg cytosol protein. Patients with er levels of 0-3, 4-9, 10-19, 20-49, and 50 fmol/mg or more cytosol protein had 20-year bca survival rates of 56%, 56%, 63%, 71%, and 60% respectively. Of the 2221 patients studied, 661 (29.8%) received anti-hormonal therapy. Within the latter group, er levels of 0-3, 4-9, 10-19, 20-49, and 50 fmol/mg or more cytosol protein were associated with a hazard ratio for lower bca mortality: respectively, 1.00 (reference), 0.59 (p = 0.09), 0.19 (p < 0.0001), 0.26 (p < 0.0001), and 0.31 (p < 0.0001)-the risk reduction being significant only for er levels of 10 fmol/mg or more cytosol protein. ConclusionsTamoxifen use in bca patients with a weakly positive er status (4-9 fmol/mg cytosol protein), compared with those having higher er levels (≥10 fmol/mg cytosol protein), is not associated with a significantly lower bca-specific mortality. Our results do not support treatment with anti-hormonal therapy for bca patients with a weakly positive er status as identified by lba.

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Adjuvant ovarian ablation vs CMF chemotherapy in premenopausal breast cancer patients: trial update and impact of immunohistochemical assessment of ER status

Cited by 47 publications

References 8 publications

Breast Cancer Version 3.2014

Breast Cancer Version 3.2014

Hormonal therapy in breast cancer: A model disease for the personalization of cancer care

Prognostic and Predictive Value of Low Estrogen Receptor Expression in Breast Cancer

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