Advertisement

Breast Cancer Research and Treatment

, Volume 54, Issue 2, pp 117–122 | Cite as

Randomized trial of diethylstilbestrol vs. tamoxifen in postmenopausal women with metastatic breast cancer. An updated analysis

  • Prema P. Peethambaram
  • James N. Ingle
  • Vera J. Suman
  • Lynn C. Hartmann
  • Charles L. Loprinzi
Article

Abstract

One hundred fifty‐one postmenopausal women with progressive metastatic breast cancer and no prior hormonal therapy were treated with either diethylstilbestrol (DES) or tamoxifen (TAM). One hundred forty‐three eligible patients were followed until death or for a minimum of 14.1 years on the DES arm or 16.7 years on the TAM arm. The overall objective response was 42% for DES and 33% for TAM (p=0.31) and the median duration of response was 11.8 months for DES and 9.9 months for TAM (p=0.38). Duration of response and progression‐free survival were not found to be significantly different between DES and TAM (p=0.32 and 0.65, respectively). The median survival was 3.0 years for DES vs. 2.4 years for TAM. The 5‐year survival was 35% for the DES arm and 16% for the TAM arm. Survival was significantly better for women on DES than for women on TAM (adjusted p=0.039). Review of records did not show any difference in pattern of treatment failure or subsequent treatments in the DES and TAM arms.

Treatment with DES was more commonly associated with toxicity such as nausea, edema, vaginal bleeding, and cardiac problems, whereas hot flashes were commonly seen with TAM therapy.

The initial treatment with DES is associated with increased survival. The basis of this survival advantage is not known. TAM still is the preferred agent in the treatment of metastatic breast cancer, but this trial underscores the fact that estrogens have activity and remain in the armamentarium for treatment of selected patients with metastatic breast cancer.

breast cancer diethylstilbestrol postmenopausal women tamoxifen 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Council On Drugs: Androgens and estrogens in the treatment of disseminated mammary carcinoma. Retrospective study of nine hundred forty four patients. JAMA 172: 1271–1283, 1960Google Scholar
  2. 2.
    Ingle JN, Ahmann DL, Green SJ, Edmonson JH, Bisel HF, Kvols LK, Nichols WC, Creagan ET, Hahn RG, Rubin J, Frytak S: Randomized clinical trial of diethylstilbestrol versus tamoxifen in postmenopausal women with advanced breast cancer. N Engl J Med 304: 16–21, 1981Google Scholar
  3. 3.
    Sedlacek SM: An overview of megestrol acetate for the treatment of advanced breast cancer. Semin Oncol 15: 3–13, 1988Google Scholar
  4. 4.
    Goss PE, Gwyn KMEH: Current perspectives on aromatase inhibitors in breast cancer. J Clin Oncol 12: 2460–2470, 1994Google Scholar
  5. 5.
    Boyer MJ, Tattersall MHN: Diethylstilbestrol revisited in advanced breast cancer management. Med Ped Oncol 18: 317–320, 1990Google Scholar
  6. 6.
    Gershanovich M, Chaudri HA, Campos D, Lurie H, Bonaventura A, Jeffrey M, Buzzi F, Bodrogi I, Ludwig H, Reichardt P, O'Higgins N, Romieu G, Friederich P, Lassus M, for the Letrozole International Trial Group (AR/BC3): Letrozole, a new oral aromatase inhibitor: Randomised trial comparing 2.5 mg daily, 0.5 mg daily and aminoglutethimide in postmenopausal women with advanced breast cancer. Ann Oncol 9: 639–645, 1998Google Scholar
  7. 7.
    Buzdar AU, Jonat W, Howell A, Jones SE, Blomqvist CP, Vogel C, Eiermann W, Wolter JM, Steinberg M, Webster A, Lee D: Anastrozole versus megestrol acetate in the treatment of postmenopausal women with advanced breast carcinoma. Cancer 83: 1142–1152, 1998Google Scholar

Copyright information

© Kluwer Academic Publishers 1999

Authors and Affiliations

  • Prema P. Peethambaram
    • 1
  • James N. Ingle
    • 1
  • Vera J. Suman
    • 1
  • Lynn C. Hartmann
    • 1
  • Charles L. Loprinzi
    • 1
  1. 1.Mayo Clinic and FoundationRochester

Personalised recommendations