Breast Cancer Research and Treatment

, Volume 137, Issue 2, pp 465–470 | Cite as

Adjuvant therapy with tamoxifen compared to aromatase inhibitors for 257 male breast cancer patients

  • Holm Eggemann
  • Atanas Ignatov
  • Bobbie J. Smith
  • Udo Altmann
  • Gunter von Minckwitz
  • Freidrich W. Röhl
  • Mark Jahn
  • Serban-Dan Costa
Clinical trial

Abstract

To determine the impact of adjuvant treatment with tamoxifen and aromatase inhibitors (AI) on the survival of men with breast cancer. We analyzed 257 male patients with hormone-receptor-positive breast cancer from numerous German population-based cancer registries treated with tamoxifen (N = 207) or aromatase inhibitors (N = 50). The median follow-up was 42.2 (range 2–115) months. Median age at diagnosis was 68 (range 36–91) years. Thirty-seven (17.9 %) patients treated with tamoxifen and 16 (32.0 %) patients treated with AI died (log rank p = 0.007). After the adjustment for the patient’s age, tumor size, node status, and tumor grading, the AI treatment was linked to a 1.5-fold increase in risk of mortality compared to tamoxifen (HR 1.55; 95 % CI: 1.13–2.13; p = 0.007). The overall survival in male breast cancer was significantly better after adjuvant treatment with tamoxifen compared to an aromatase inhibitor. Tamoxifen should be considered as the treatment of choice for hormone-receptor-positive male breast cancer.

Keywords

Male breast cancer Tamoxifen Aromatase inhibitor Adjuvant treatment 

List of abbreviations

AI

Aromatase inhibitors

CI

Confidence interval

DCIS

Ductal carcinoma in situ

ER

Estrogen receptor human epidermal growth factor

HER2

Receptor 2

HR

Hazard ratio

MBC

Male breast cancer

N

Number

OS

Overall survival

PR

Progesterone receptor

TAM

Tamoxifen

References

  1. 1.
    Fentiman IS, Fourquet A, Hortobagyi GN (2006) Male breast cancer. Lancet 367:595–604PubMedCrossRefGoogle Scholar
  2. 2.
    Korde LA, Zujewski JA, Kamin L (2010) Multidisciplinary meeting on male breast cancer: summary and research recommendations. J Clin Oncol 28(12):2114–2122PubMedCrossRefGoogle Scholar
  3. 3.
    Giordano SH, Cohen DS, Buzdar AU et al (2004) Breast carcinoma in men: a population-based study. Cancer 101:51–57PubMedCrossRefGoogle Scholar
  4. 4.
    Agrawal A, Ayantunde AA, Rampaul R et al (2007) Male breast cancer: a review of clinical management. Breast Cancer Res Treat 103:11–21PubMedCrossRefGoogle Scholar
  5. 5.
    Contractor KB, Kaur K, Rodrigues GS et al (2008) Male breast cancer: is the scenario changing. World J Surg Oncol 6:58PubMedCrossRefGoogle Scholar
  6. 6.
    Cardoso F, Costa A, Norton L, et al (2012) 1st International consensus guidelines for advanced breast cancer (ABC 1). Breast doi:10.1016/j.breast.2012.03.003
  7. 7.
    Lück HJ, Lux M (2012) Breast cancer: specific situations in Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (ed):Diagnosis and treatment of patients with primary and metastatic Breast cancer v. 2012.1, Arbeitsgemeinschaft Gynäkologische Onkologie e.V. http://www.ago-online.de/de/fuer-mediziner/leitlinien/mamma/ (zip file, English version, pp 260-261)
  8. 8.
    Oxford Centre for Evidence-based Medicine—Levels of Evidence (March 2009) http://www.cebm.net/index.aspx?o=1025
  9. 9.
    Giordano SH (2005) A review of the diagnosis and management of male breast cancer. Oncologist 10:471–479PubMedCrossRefGoogle Scholar
  10. 10.
    Cutuli B, Lacroze M, Dilhuydy JM et al (1995) Male breast cancer: results of the treatments and prognostic factors in 397 cases. Eur J Cancer 31A:1960–1964PubMedCrossRefGoogle Scholar
  11. 11.
    Weber-Chappuis K, Bieri-Burger S, Hurlimann J (1996) Comparison of prognostic markers detected by immunohistochemistry in male and female breast carcinomas. Eur J Cancer 32A:1686–1692PubMedCrossRefGoogle Scholar
  12. 12.
    Fogh S, Hirsch AE, Langmead JP et al (2011) Use of tamoxifen with postsurgical irradiation may improve survival in estrogen and progesterone receptor-positive male breast cancer. Clin Breast Cancer 11:39–45PubMedCrossRefGoogle Scholar
  13. 13.
    Giordano SH, Perkins GH, Broglio K et al (2005) Adjuvant systemic therapy for male breast carcinoma. Cancer 104:2359–2364PubMedCrossRefGoogle Scholar
  14. 14.
    Goss PE, Reid C, Pintilie M et al (1999) Male breast carcinoma: a review of 229 patients who presented to the Princess Margaret Hospital during 40 years: 1955–1996. Cancer 85:629–639PubMedCrossRefGoogle Scholar
  15. 15.
    Harlan LC, Zujewski JA, Goodman MT et al (2010) Breast cancer in men in the United States: a population-based study of diagnosis, treatment, and survival. Cancer 116:3558–3568PubMedCrossRefGoogle Scholar
  16. 16.
    Ribeiro G, Swindell R (1992) Adjuvant tamoxifen for male breast cancer (MBC). Br J Cancer 65:252–254PubMedCrossRefGoogle Scholar
  17. 17.
    Ribeiro G (1983) Tamoxifen in the treatment of male breast carcinoma. Clin Radiol 34:625–628PubMedCrossRefGoogle Scholar
  18. 18.
    Salvadori B, Saccozzi R, Manzari A et al (1994) Prognosis of breast cancer in males: an analysis of 170 cases. Eur J Cancer 30A:930–935PubMedCrossRefGoogle Scholar
  19. 19.
    Nordman IC, Dalley DN (2008) Breast cancer in men: should aromatase inhibitors become first-line hormonal treatment? Breast J 14:562–569PubMedCrossRefGoogle Scholar
  20. 20.
    Baum M, Budzar AU, Cuzick J et al (2002) Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer: first results of the ATAC randomised trial. Lancet 359:2131–2139PubMedCrossRefGoogle Scholar
  21. 21.
    Coates AS, Keshaviah A, Thurlimann B et al (2007) Five years of letrozole compared with tamoxifen as initial adjuvant therapy for postmenopausal women with endocrine-responsive early breast cancer: update of study BIG 1–98. J Clin Oncol 25:486–492PubMedCrossRefGoogle Scholar
  22. 22.
    Coombes RC, Hall E, Gibson LJ et al (2004) A randomized trial of exemestane after two to three years of tamoxifen therapy in postmenopausal women with primary breast cancer. N Engl J Med 350:1081–1092PubMedCrossRefGoogle Scholar
  23. 23.
    Volm MD (2003) Male breast cancer. Curr Treat Options Oncol 4:159–164PubMedCrossRefGoogle Scholar
  24. 24.
    Zumoff B, Fishman J, Cassouto J et al (1966) Estradiol transformation in men with breast cancer. J Clin Endocrinol Metab 26:960–966PubMedCrossRefGoogle Scholar
  25. 25.
    Mauras N, O’Brien KO, Klein KO et al (2000) Estrogen suppression in males: metabolic effects. J Clin Endocrinol Metab 85:2370–2377PubMedCrossRefGoogle Scholar
  26. 26.
    Ellinwood WE, Hess DL, Roselli CE et al (1984) Inhibition of aromatization stimulates luteinizing hormone and testosterone secretion in adult male rhesus monkeys. J Clin Endocrinol Metab 59:1088–1096PubMedCrossRefGoogle Scholar
  27. 27.
    Shetty G, Krishnamurthy H, Krishnamurthy HN et al (1998) Effect of long-term treatment with aromatase inhibitor on testicular function of adult male bonnet monkeys (M. radiata). Steroids 63:414–420PubMedCrossRefGoogle Scholar
  28. 28.
    Roselli CE, Resko JA (1997) Sex differences in androgen-regulated expression of cytochrome P450 aromatase in the rat brain. J Steroid Biochem Mol Biol 61:365–374PubMedCrossRefGoogle Scholar
  29. 29.
    Early Breast Cancer Trialists’ Collaborative Group: Tamoxifen for early Breast cancer: an overview of the randomised trials. Lancet 351:1451–1467, 1998Google Scholar
  30. 30.
    Powles TJ, Ashley S, Tidy A et al (2007) Twenty-year follow-up of the Royal Marsden randomized, double-blinded tamoxifen breast cancer prevention trial. J Natl Cancer Inst 99:283–290PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Holm Eggemann
    • 1
  • Atanas Ignatov
    • 1
  • Bobbie J. Smith
    • 2
  • Udo Altmann
    • 3
  • Gunter von Minckwitz
    • 4
  • Freidrich W. Röhl
    • 5
  • Mark Jahn
    • 6
  • Serban-Dan Costa
    • 1
  1. 1.University Women’s ClinicOtto-von-Guericke UniversityMagdeburgGermany
  2. 2.Hannover Medical SchoolHannoverGermany
  3. 3.Clinical Tumor Registry CoordinationJustus Liebig UniversityGiessenGermany
  4. 4.German Breast GroupNeu-IsenburgGermany
  5. 5.Institute of Biometrics and Medical InformaticsOtto-von-Guericke UniversityMagdeburgGermany
  6. 6.Helios Klinikum, Berlin BuchBerlinGermany

Personalised recommendations