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Relation of estrogen and/or progesterone receptor content of breast cancer to patient outcome following adjuvant chemotherapy

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Summary

In 1977 the National Surgical Adjuvant Breast and Bowel Project (NSABP) initiated a prospectively randomized clinical trial to evaluate the relative merits of 1-phenylalanine mustard and 5-fluorouracil (PF) with and without tamoxifen (T) as adjuvant therapy for patients with primary breast cancer and positive axillary nodes. A previous presentation of findings noted that there was a strong relationship between the outcome of those receiving PFT and the estrogen receptor (ER) and progesterone receptor (PR) content of their tumors. This report relates the outcome of the PF-treated patients in that trial with these tumor receptors. It indicates that the results observed following nonhormonal therapy (PF) are also related to tumor receptors.

Both the disease-free survival (DFS) and survival (S) of women following PF therapy were influenced by the ER and PR content of their tumors. Subsequent to adjustment for other prognostic variables, the predictive influence of tumor ER persisted. Both the DFS (p = 0.0003) and the S (p = 0.00003) were significantly higher in those with ≥ 10 fmol tumor ER than in those with < 10 fmol ER. The PR significantly added to the predictive value of ER. Thus, this analysis is the first to demonstrate that having information on both ER and PR is important for predicting outcome of patients receiving adjuvant chemotherapy. The study does not provide information which correlates receptor status with the response of patients to adjuvant chemotherapy since there is no similar nonchemotherapy-treated group of patients in the trial. The findings continue to emphasize that there is a heterogeneity in outcome of breast cancer patients to adjuvant chemotherapy which is related to an increasing number of host and tumor variables. For proper assessment of overall results, it is essential that analyses employ tests for interaction to indicate homogeneity or heterogeneity of patient subsets and that adjustments be made for imbalances in tumor ER and PR as well as in other prognostic factors.

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Authors and Affiliations

  1. Department of Surgery, School of Medicine, University of Pittsburgh, 15261, Pittsburgh, PA, USA

    Bernard Fisher & D. Lawrence Wickerham

  2. Department of Biostatistics, University of Pittsburgh, 15260, Pittsburgh, PA, USA

    Carol K. Redmond & Howard E. Rockette

  3. NSABP Biostatistical Center, University of Pittsburgh, 15213, Pittsburgh, PA, USA

    Ann Brown

  4. Department of Medical Oncology, James Graham Brown Cancer Center, 40292, Louisville, KY, USA

    Joseph Allegra (contributions)

  5. Manitoba Cancer Treatment and Research Foundation, Health Sciences Center, R3E 0V9, Winnipeg, Manitoba, Canada

    David Bowman

  6. Memorial Cancer Research Foundation of Southern California, 90230, Culver City, CA, USA

    David Plotkin

  7. Department of Medical Oncology, Rush Presbyterian-St. Luke's Hospital, 60612, Chicago, IL, USA

    Janet Wolter

Authors
  1. Bernard Fisher
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  2. Carol K. Redmond
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  3. D. Lawrence Wickerham
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  4. Howard E. Rockette
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  5. Ann Brown
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  6. Joseph Allegra
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  7. David Bowman
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  8. David Plotkin
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  9. Janet Wolter
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other NSABP investigators

Additional information

See Appendix I for a list of NSABP Institutions and Principal Investigators participating in Protocol No. B-09.

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Fisher, B., Redmond, C.K., Wickerham, D.L. et al. Relation of estrogen and/or progesterone receptor content of breast cancer to patient outcome following adjuvant chemotherapy. Breast Cancer Res Tr 3, 355–364 (1983). https://doi.org/10.1007/BF01807588

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  • DOI: https://doi.org/10.1007/BF01807588

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