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

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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.

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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. Fentiman IS, Fourquet A, Hortobagyi GN (2006) Male breast cancer. Lancet 367:595–604

    Article  PubMed  Google Scholar 

  2. Korde LA, Zujewski JA, Kamin L (2010) Multidisciplinary meeting on male breast cancer: summary and research recommendations. J Clin Oncol 28(12):2114–2122

    Article  PubMed  Google Scholar 

  3. Giordano SH, Cohen DS, Buzdar AU et al (2004) Breast carcinoma in men: a population-based study. Cancer 101:51–57

    Article  PubMed  Google Scholar 

  4. Agrawal A, Ayantunde AA, Rampaul R et al (2007) Male breast cancer: a review of clinical management. Breast Cancer Res Treat 103:11–21

    Article  PubMed  CAS  Google Scholar 

  5. Contractor KB, Kaur K, Rodrigues GS et al (2008) Male breast cancer: is the scenario changing. World J Surg Oncol 6:58

    Article  PubMed  Google Scholar 

  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. 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. Oxford Centre for Evidence-based Medicine—Levels of Evidence (March 2009) http://www.cebm.net/index.aspx?o=1025

  9. Giordano SH (2005) A review of the diagnosis and management of male breast cancer. Oncologist 10:471–479

    Article  PubMed  Google Scholar 

  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:1960–1964

    Article  PubMed  CAS  Google Scholar 

  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:1686–1692

    Article  PubMed  CAS  Google Scholar 

  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 11:39–45

    Article  PubMed  CAS  Google Scholar 

  13. Giordano SH, Perkins GH, Broglio K et al (2005) Adjuvant systemic therapy for male breast carcinoma. Cancer 104:2359–2364

    Article  PubMed  Google Scholar 

  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 85:629–639

    Article  PubMed  CAS  Google Scholar 

  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 116:3558–3568

    Article  PubMed  Google Scholar 

  16. Ribeiro G, Swindell R (1992) Adjuvant tamoxifen for male breast cancer (MBC). Br J Cancer 65:252–254

    Article  PubMed  CAS  Google Scholar 

  17. Ribeiro G (1983) Tamoxifen in the treatment of male breast carcinoma. Clin Radiol 34:625–628

    Article  PubMed  CAS  Google Scholar 

  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:930–935

    Article  PubMed  CAS  Google Scholar 

  19. Nordman IC, Dalley DN (2008) Breast cancer in men: should aromatase inhibitors become first-line hormonal treatment? Breast J 14:562–569

    Article  PubMed  CAS  Google Scholar 

  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 359:2131–2139

    Article  PubMed  CAS  Google Scholar 

  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 25:486–492

    Article  PubMed  CAS  Google Scholar 

  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 350:1081–1092

    Article  PubMed  CAS  Google Scholar 

  23. Volm MD (2003) Male breast cancer. Curr Treat Options Oncol 4:159–164

    Article  PubMed  Google Scholar 

  24. Zumoff B, Fishman J, Cassouto J et al (1966) Estradiol transformation in men with breast cancer. J Clin Endocrinol Metab 26:960–966

    Article  PubMed  CAS  Google Scholar 

  25. Mauras N, O’Brien KO, Klein KO et al (2000) Estrogen suppression in males: metabolic effects. J Clin Endocrinol Metab 85:2370–2377

    Article  PubMed  CAS  Google Scholar 

  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 59:1088–1096

    Article  PubMed  CAS  Google Scholar 

  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 63:414–420

    Article  PubMed  CAS  Google Scholar 

  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 61:365–374

    Article  PubMed  CAS  Google Scholar 

  29. Early Breast Cancer Trialists’ Collaborative Group: Tamoxifen for early Breast cancer: an overview of the randomised trials. Lancet 351:1451–1467, 1998

    Google Scholar 

  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 99:283–290

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We would like to thank Mathias Uhlig, PhD, Sabine Kleinefeld, and Christiane Praetor for their excellent work in project and data management.

We would also like to thank the following cancer registries for their cooperation, without which this study would not have been possible: Tumorzentrum Augsburg, Krebsregister in Klinikum Bayreuth GmbH, St. Gertrauden-Krankenhaus (Tumorzentrum gemeinnütziger und konfessioneller Krankenhäuser in Berlin (TZGKB)), Vivantes Tumorzentrum (Berlin), Tumorzentrums Chemnitz e.V., Tumorzentrum of the Staedische Klinikum in Dessau, Tumorzentrum Erfurt e.V., Tumorzentrum Ludwig Heilmeyer (Comprehensive Cancer Center Freiburg), Arbeitsgruppe zur Koordination Klinischer Krebsregister (AKKK) Giessen, Tumorzentrum Ostsachsen e. V. Goerlitz, Tumorzentrum Halle, Gynaekologisches Tumorzentrum am Diakonie-Klinikum Hamburg, Tumorzentrum Heilbronn-Franken, HELIOS Klinikum Berlin Buch, UniversitätsTumorCentrum Jena, Tumorzentrum Koblenz am Kemperhof, Tumorzentrum Land Brandenburg, Tumorzentrum Magdeburg/Sachsen-Anhalt e.V., Tumorzentrum Neubrandenburg, Tumorzentrum Südharz e.V. in Nordhausen, Krebsregister Rostock, Tumorzentrum Schwerin-Westmecklenburg, Tumorzentrum Suhl e. V., and the Tumorzentrum Zwickau e.V.

Conflict of interests

The authors declare no conflicts of interest.

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Authors and Affiliations

  1. University Women’s Clinic, Otto-von-Guericke University, Gerhart-Hauptmann Str. 35, 39108, Magdeburg, Germany

    Holm Eggemann, Atanas Ignatov & Serban-Dan Costa

  2. Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany

    Bobbie J. Smith

  3. Clinical Tumor Registry Coordination, Justus Liebig University, Heinrich-Buff-Ring 44, 35392, Giessen, Germany

    Udo Altmann

  4. German Breast Group, Martin-Behaim-Str. 12, 63263, Neu-Isenburg, Germany

    Gunter von Minckwitz

  5. Institute of Biometrics and Medical Informatics, Otto-von-Guericke University, Leipziger Str. 44, 39120, Magdeburg, Germany

    Freidrich W. Röhl

  6. Helios Klinikum, Berlin Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany

    Mark Jahn

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  1. Holm Eggemann
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  2. Atanas Ignatov
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Correspondence to Holm Eggemann.

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Eggemann, H., Ignatov, A., Smith, B.J. et al. Adjuvant therapy with tamoxifen compared to aromatase inhibitors for 257 male breast cancer patients. Breast Cancer Res Treat 137, 465–470 (2013). https://doi.org/10.1007/s10549-012-2355-3

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  • DOI: https://doi.org/10.1007/s10549-012-2355-3

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