Primary endocrine therapy for advanced breast cancer: To start with tamoxifen or with medroxyprogesterone acetate?

Castiglione‐Gertsch, Monica; Pampallona, Sandro; Varini, M.; Cavalli, F.; Brunner, K. W.; Senn, HJ; Goldhirsch, Aron; Metzger, U

doi:10.1093/oxfordjournals.annonc.a058657

Cited by 27 publications

(6 citation statements)

References 9 publications

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“…This is more than twice as high as compared to the average mean rate of 1.7% (range of means: 0-5.6%) found in eight studies during tamoxifen mono therapy based on a total of 3,184 patients without metastasis (7,54,63,64,(67)(68)(69)(70). Tamoxifen or toremifen mono therapy for metastatic breast cancer in 3,370 patients from five studies (71)(72)(73)(74)(75) revealed no increased rate for DVT (average mean DVT incidence 2.1%; range of means: 0.8-3.2%) compared to adjuvant tamoxifen mono therapy. A representative trial by the Stockholm Breast Cancer Study Group found no significant differences in the incidence of hospital admissions due to DVT in 2,365 postmenopausal patients who were randomly assigned to either adjuvant tamoxifen treatment (49/1188; 4.1%) (94).…”

Section: Thrombosis Incidencementioning

confidence: 91%

State-of-the-Art Review : Chemotherapy and Thrombosis in Gynecologic Malignancy

Gf¹,

Pollow²,

Schneider³

et al. 1999

Clin Appl Thromb Hemost

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The occurrence of deep vein thrombosis (DVT) in gynecologic cancer patients has a multifactorial genesis.Besides the older age of patients and the coexistence of additional thrombosis favoring illnesses such as obesity, hypertension, metabolic and cardiovascular disorders, and others, therapeutic management can be an independent risk factor for DVT. Radical surgery for pelvic genital cancer leads to an incidence of postoperative DVT between 6% in ovarian cancer and up to 20% in cervical or endometrial cancer patients (1). The rate for DVT after breast cancer surgery does not exceed 3 % (2-4) and breast cancer patients under observation were found to experience DVT at a rate of 0% to 3.28% (5-7) compared to an overall incidence per year of about 0.3% in women (8). Radiotherapy, especially during intrauterine/ vaginal radium application for 12 to 24 hours, in uterine cancer patients has a reported rate between 2.5% and 6.8%. These rates occur whether or not thrombosis prophylaxis with either a daily dose of low molecular weight heparin (LMWH) administered subcutaneously or oral anticoagulation with warfarin was given (9-11). In a recent postmortem study (12), among 966 consecutive autopsies with thrombosis and/or pulmonary embolism (PE), cancer was coincident in 56% of cases. Breast cancer (5.7%) and cervical cancer (2.4%) were among the four most frequent cancer types and were significantly over represented when compared to a control group of 325 consecutive and unselected autopsies without DVT (3.1 % and 0.6%; p < .05).The most comprehensive data on thrombotic complications in gynecologic malignancy were drawn from studies of breast cancer patients in association with cytoreductive therapy and showed an approximate average incidence of 5%. These results are substantial since most patients with breast and ovarian cancer will receive chemotherapy for adjuvant and/or palliative settings some time in the course of their disease.Deep vein thrombosis is a frequent complication in gynecologic malignancy and should be considered when planning therapeutic management of patients. This article discusses the prethrombotic state and the rate of thrombotic complications in patients receiving standard cytoreductive therapy for breast and ovarian cancer and the possible mechanisms of chemotherapy-induced thrombosis. The results of recent thrombosis prevention trials are summarized.

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Section: Thrombosis Incidencementioning

confidence: 91%

State-of-the-Art Review : Chemotherapy and Thrombosis in Gynecologic Malignancy

Gf¹,

Pollow²,

Schneider³

et al. 1999

Clin Appl Thromb Hemost

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“…Thus, the sequential use of different hormonal agents is an attractive choice of treatment for recurrent breast cancer patients. Several clinical cross-over trials comparing the efficacy of two different hormonal agents for recurrent breast cancer have been conducted but showed no significant difference in response rates, time to treatment failure and survival [5, 6, 7, 8, 9, 10, 11]. However, the hormonal agents used in these trials did not include the recently developed new hormonal agents, such as LH-RH agonists and the new-generation aromatase inhibitors.…”

Section: Introductionmentioning

confidence: 99%

Endocrine Therapies for Patients with Recurrent Breast Cancer: Predictive Factors for Responses to First- and Second-Line Endocrine Therapies

Kurebayashi

Sonoo

Inaji³

et al. 2000

Oncology

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Breast cancer patients have been treated with four different hormonal agents, antiestrogen, progestin, luteinizing hormone-releasing hormone agonist and aromatase inhibitor, during the past 7 years in Japan. To investigate the efficacy of these agents for the treatment of recurrent breast cancer patients, we conducted a retrospective multi-institute survey in Japan. The clinico-pathological data of 131 patients, who received endocrine therapy as first-line treatment between 1993 and 1998, were collected from seven institutes. The median age of the patients was 55 (range 27–92) years, 75% of their primary tumors were estrogen receptor (ER)-positive or unknown, and 95% of the dominant metastatic sites were bone, soft tissue or lungs. The objective response rate to first-line endocrine therapy was 42.7%, and that to second-line therapy 42.5% (17 of 40 patients). Multiple regression analyses of predictive factors for a response to first- and second-line endocrine therapies indicated two independent factors, ER status of the primary tumors and dominant site of metastasis, for the former, and one independent factor, a response to first-line endocrine therapy, for the latter. Analysis of relationships between sequences of use of hormonal agents and objective response rates revealed that the choice of first-line hormonal agent did not influence the overall efficacy of first- and second-line endocrine therapies. Overall survival after first recurrence in patients with tumors exhibiting an objective response or stable disease to first-line endocrine therapy was significantly better than that in patients with tumors exhibiting progressive disease (p < 0.01). These findings suggest that an adequate selection of recurrent breast cancer patients referring the ER status, dominant site of metastasis and a prior response to endocrine therapy may contribute to better clinical outcomes of the patients.

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“…Comparative evaluations of the relative efficacy of tamoxifen and progestogens (especially at high dosages) provided evidence of an at least equipotent or even better antitumoural activity of the progestogens (Mattson, 1980;Löber et al, 1981;Van Veelen et al, 1986;Muss et al, 1988;Muss et al, 1990;Castiglione-Gertsch et al, 1993;Gill et al, 1993).…”

mentioning

confidence: 99%

“…Moreover, after having crossed-over, progestogens retained some antitumour efficacy after tamoxifen's failure (Mattson, 1980;Löber et al, 1981;Van Veelen et al, 1986;Muss et al, 1988;Muss et al, 1990;Castiglione-Gertsch et al, 1993;Gill et al, 1993). Some trials (Castiglione-Gertsch et al, 1993) suggested that tamoxifen's primacy may be challenged particularly by the use of progestogens in patients suffering from bone metastases (Muss et al, 1988;Muss et al, 1990;Castiglione-Gertsch et al, 1993;Gill et al, 1993).…”

mentioning

confidence: 99%

“…Some trials (Castiglione-Gertsch et al, 1993) suggested that tamoxifen's primacy may be challenged particularly by the use of progestogens in patients suffering from bone metastases (Muss et al, 1988;Muss et al, 1990;Castiglione-Gertsch et al, 1993;Gill et al, 1993). In those trials, as already observed, the dose of progestogen (Mattson, 1980;Löber et al, 1981;Cavalli et al, 1984;Tchekmedyian et al, 1986;Van-Veelen et al, 1986) could be of paramount for determining the antitumor efficacy of these agents: high doses of drugs could significantly increase the response rate and even, in some observations, prolong time to treatment failure and survival (Mattson, 1980;Löber et al, 1981;Cavalli et al, 1984;Tchekmedyian et al, 1986;Van Veelen et al, 1986).…”

mentioning

confidence: 99%

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Adjuvant high-dose medroxyprogesterone acetate for early breast cancer: 13 years update in a multicentre randomized trial

et al. 2001

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SummaryThe authors updated their report on a randomized trial initiated in 1982 comparing, in early breast cancer, high-dose IM Medroxyprogesterone acetate (HD-MPA) adjuvant hormonotherapy during 6 months with no hormonotherapy; node-positive patients also received 6 courses of IV CMF (day 1, day 8; q.4 weeks). 246 node-negative (NN) and 270 node-positive (NP) patients had been followed for a median duration of 13 years. Previous results were confirmed in this analysis on mature data. In NN patients, relapse-free survival (RFS) was improved in the adjuvant hormonotherapy arm, regardless of age while overall survival (OAS) was also increased in younger (less then 50 years) patients. In the whole group of NP patients, no difference was seen regarding RFS or OAS. However, an age-dependant opposite effect was observed: younger patients (< 50) experienced a worse and significant outcome of relapse-free and overall survivals when receiving adjuvant HD-MPA while older patients (> = 50) enjoyed a significant improvement of their relapse-free survival. For both NN and NP patients, differences in overall survivals observed in older women with a shorter follow-up, were no longer detected.

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Primary endocrine therapy for advanced breast cancer: To start with tamoxifen or with medroxyprogesterone acetate?

Cited by 27 publications

References 9 publications

State-of-the-Art Review : Chemotherapy and Thrombosis in Gynecologic Malignancy

State-of-the-Art Review : Chemotherapy and Thrombosis in Gynecologic Malignancy

Endocrine Therapies for Patients with Recurrent Breast Cancer: Predictive Factors for Responses to First- and Second-Line Endocrine Therapies

Adjuvant high-dose medroxyprogesterone acetate for early breast cancer: 13 years update in a multicentre randomized trial

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