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Primary endocrine therapy in locally advanced breast cancers—the Nottingham experience

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Abstract

Introduction There are trials comparing different neoadjuvant chemotherapy regimens for locally advanced primary breast cancer (LAPC). Few studies have evaluated alternative therapeutic approaches towards LAPC. A previous trial from our institute in LAPC patients unselected for oestrogen receptor (ER) status, comparing primary endocrine therapy versus multimodal treatment, showed no difference in breast cancer related deaths or overall survival. We report our experience of primary endocrine therapy in ER+ LAPC. Methods Between 1988 and 2007, 195 ER+, non-inflammatory LAPC patients were treated with primary endocrine agents in our institute, due to patient choice, being unfit for chemotherapy, or recruitment into the above mentioned trial. All patients had disease assessable by UICC criteria. Results Median age was 69 years. The median follow-up was 61 months. 154 patients (79%) received endocrine treatment alone. 185 patients (95%) derived clinical benefit (complete response/ partial response/ stable disease) for ≥6 months from primary endocrine therapy. Overall 5-year survival was 76% and 5-year breast cancer specific survival was 86%. Conclusion In selected group of ER+ LAPC patients, primary endocrine treatment achieves excellent survival outcome and is a viable alternative to other modalities of treatment.

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References

  1. Lebowitz PF, Eng-Wong Jennifer, Swain SM et al (2004) A phase 11 trial of neoadjuvant docetaxel and capecitabine for locally advanced breast cancer. Clin Cancer Res 10:6764–6769

    Article  PubMed  CAS  Google Scholar 

  2. Charfare H, Limongelli S, Purushotham AD (2005) Neoadjuvant chemotherapy in breast cancer. Br J Surg 92:14–23

    Article  PubMed  CAS  Google Scholar 

  3. Colleoni M, Gelber S, Coates AS et al (2001) Influence of endocrine-related factors on response to perioperative chemotherapy for patients with node negative breast cancer. J Clinin Oncol 19:4141–4149

    CAS  Google Scholar 

  4. Gianni L, Baselga J, Eiermann W et al (2002) First report of European cooperative tral in operable breast cancer (ECTO): effects of primary systemic therapy on loco-regional disease (abstract). Proc Am Soc Clin Oncol 21: Abstract 132

  5. Singletary SE, Shallenberger R, Guinee VF (1993) Breast cancer in the elderly. Ann Surg 218(5):667–671

    Article  PubMed  CAS  Google Scholar 

  6. Busch E, Kemeny M, Fremgen A et al (1996) Patterns of breast cancer care in the elderly. Cancer 78(1):101–111

    Article  PubMed  CAS  Google Scholar 

  7. McCarty KS Jr, Silva JS, Cox EB et al (1983) Relationship of age and menopausal status to estrogen receptor content in primary carcinoma of the breast. Ann Surg 197:123–127

    Article  PubMed  Google Scholar 

  8. Early Breast Cancer Trialists Collaborative Group (2000) Analysis overview results. Fifth meeting of early breast cancer trialists collaborative group. Oxford, UK, pp 21–23

  9. Robertson JF, Ellis IO, Elston CW, Blamey RW (1992) Mastectomy or tamoxifen as initial therapy for operable breast cancerin elderly patients: 5 year follow-up. Eur J cancer 28A:908–910

    Article  PubMed  CAS  Google Scholar 

  10. Gazet JC, Ford HT, Coombes RC et al (1994) Prospective randomised trial of tamoxifen vs surgery in elderly patients with breast cancer. Eur J Surg Oncol 20:207–14

    PubMed  CAS  Google Scholar 

  11. Bates T, Riley DL, Houghton J et al (1991) Breast cancer in elderly women: a cancer research campaign trial comparing treatment with tamoxifen and optimal surgery with tamoxifen alone. The early breast cancer working party. BHr J Surg 78:591–4

    Article  CAS  Google Scholar 

  12. Mustacchi G, Milani S, Pluchinotta A et al (1994) Tamoxifen or surgery plus tamoxifen as primary treatment for elderly patients with operable breast cancer: The G.R.E.T.A. trial. Group for research on endocrine therapy in the elderly. Anticancer Res 14:2197–200

    PubMed  CAS  Google Scholar 

  13. Tan SM, Cheung KL, Willsher PC, Blamey RW, Chan SY, Robertson JFR (2001) Locally advanced primary breast cancer: medium-term results of a randomised trial of multimodal therapy versus initial hormone therapy. EJC 37:2331–2338

    Article  CAS  Google Scholar 

  14. Harper-Wyne L Catherine, Sacks NPM, Shenton K (2002) Comparison of the systemic and intramural effects of tamoxifen and aromatase inhibitor vorozole in postmenopausal patients with primary breast cancer. J Clin Oncol 20:1026–1035

    Article  Google Scholar 

  15. Hayward J et al (1977) Assessment of response to therapy in advanced breast cancer. Cancer 39:1289–1293

    Article  PubMed  CAS  Google Scholar 

  16. Thomas E, Homes FA, Smith TL, Budzar AU, Fyre DK, Frachini G et al (2004) The use of alternative, non-cross resistant adjuvant chemotherapy on the basis of pathologic response to a neoadjuvant doxorubicin-based regimen in women with operable breast cancer: Long-term results from a prospective randomised trial. J of Clin Oncol 22:2294–2302

    Article  CAS  Google Scholar 

  17. Gradisher W, Wedam B, Jahanzeb M et al (2005) Neoadjuvant docetaxel followed by adjuvant doxorubicin and cyclophosphamide in patients with stage III breast cancer. Ann Oncol 16:1297–1304

    Article  Google Scholar 

  18. Shen J, Valero V, Buchholz TA, Singletray SE, Ames FC, Ross M et al (2004) Effective local control and long-term survival in patients with T4 locally advanced breast cancer treated with breast conservation therapy. Ann Surg Oncol 11:854–860

    Article  PubMed  Google Scholar 

  19. Erol K, Baltali E, Altundag K et al (2005) Neoadjuvantt chemotherapy with cyclophosphamide, mithotrixate and 5-Flurouracil in locally advanced breast cancer. Onkologie 28:81–85

    Article  PubMed  CAS  Google Scholar 

  20. Favret A, Carlson R, Goffinet D et al (2001) Locally advanced breast cancer: Is surgery necessory? Breast J 7:131–137

    Article  PubMed  CAS  Google Scholar 

  21. Bonadonna G, Valagussa P, Brambilla C et al (1998) Primary chemotherapy in operable breast cancer: Eight year experience at the Milan cancer institute. J Clin Oncol 16:93–100

    PubMed  CAS  Google Scholar 

  22. Fisher B, Bryant J, Wolmark N et al (1998) Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol 16:2672–2685

    PubMed  CAS  Google Scholar 

  23. Howell A, Mackintosh J, Jones M et al (1998) The definition of ‘no change’ category in patients treated with endocrine therapy and chemotherapy for advanced carcinoma of the breast. Eur J Cancer Clin Oncol 24:1267–1272

    Google Scholar 

  24. Robertson J, Willsher PC, Cheung KL et al (1997) The clinical relevance of static disease (no change) category for 6 months on endocrine therapy in patients with breast cancer. Eur J Cancer Oncol 33:1774–1779

    Article  CAS  Google Scholar 

  25. Robertson J, Howell A, Buzdar A et al (1999) Static disease on anastrozole provides similar benefit as objective response in patients with advanced breast cancer. Breast Cancer Res Treat 58:157–162

    Article  PubMed  CAS  Google Scholar 

  26. Mouridsen H, Sun Y, Gershanovich M, Perez-Carrion R et al (2004) Superiority of Letrozole to Tamoxifen in the first-line treatment of advanced breast cancer: evidence from metastatic subgroups and a test of functional ability. Oncologist 9(5):489–496

    Article  PubMed  CAS  Google Scholar 

  27. Thurlimann B, Hess D, Koberle D et al (2004) Anastrozole (Arimidex) versus Tamoxifen as first-line therapy in post-menopausal women with advanced breast cancer: results of double blind cross-over SAKK trial 21/95- a sub-study of the TARGET(Tamoxifen or Arimidex Randomised group efficacy and tolerability) trial. Breast Cancer Res Treat 85(3):247–254

    Article  PubMed  Google Scholar 

  28. Mathew J, Asgeirsson KS, Agrawal A (2007) Neoadjuvant chemotherapy in locally advanced primary breast cancers: the Nottingham experience. Eur J Surg Oncol 33(8):972–976

    PubMed  CAS  Google Scholar 

  29. Williams MR, Gilson D, Marsh L et al (1998) The early results from a randomised study of radiotherapy versus Nolvadex (Tamoxifen) as initial treatment for stage 111 breast cancer. EJSO 14(3):235–240

    Google Scholar 

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Authors and Affiliations

  1. Division of Breast Surgery, University of Nottingham, Nottingham, UK

    J. Mathew, A. Agrawal, K. S. Asgeirsson, S. A. Buhari, L. R. Jackson, K. L. Cheung & J. F. R. Robertson

  2. Professorial Unit of Surgery, City Hospital Campus, Nottingham University Hospitals, Hucknall Road, Nottingham, NG5 1PB, UK

    J. F. R. Robertson

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  1. J. Mathew
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  2. A. Agrawal
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  3. K. S. Asgeirsson
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  4. S. A. Buhari
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  5. L. R. Jackson
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  6. K. L. Cheung
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  7. J. F. R. Robertson
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Correspondence to J. Mathew or J. F. R. Robertson.

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Mathew, J., Agrawal, A., Asgeirsson, K.S. et al. Primary endocrine therapy in locally advanced breast cancers—the Nottingham experience. Breast Cancer Res Treat 113, 403–407 (2009). https://doi.org/10.1007/s10549-008-9930-7

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  • DOI: https://doi.org/10.1007/s10549-008-9930-7

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