Hormone Therapy for Locally Advanced Disease

A team of British researchers has concluded that an initial course of hormone therapy may be an option for some women with locally advanced breast cancer, especially if they have estrogen receptor-positive disease, but possibly with considerable risk.

Writing in the European Journal of Cancer, Dr. S.M. Tan of City Hospital in Nottingham, UK and colleagues reported on their study of 108 women with locally advanced primary breast cancer. Half of the women received an initial course of hormone therapy with no other treatment, while the other half received multimodal therapy consisting of surgery, radiotherapy and chemotherapy. The hormone therapy group took daily tamoxifen alone (for postmenopausal women) or daily tamoxifen plus monthly goserelin for premenopausal women. This continued until there were signs of disease progression, at which point the patients received surgery, radiation, or chemotherapy as appropriate.

The researchers noticed a treatment response in 56 percent of the women receiving the multimodal therapy, compared to only 35 percent of the women receiving initial hormone therapy. The multimodal therapy also resulted in a more rapid response rate and a longer time to disease progression than the hormonal therapy.

Importantly, Tan's group found that more than 80 percent of the women who began their treatment with only hormonal therapy eventually required additional local treatment.

The researchers found that women with estrogen receptor-positive tumors fared better with the hormone therapy than those with estrogen receptor-negative disease. In fact, regardless of the therapy groups, estrogen receptor-positive tumors had a lower metastasis rate, longer survival and better locoregional control

"Initial hormone therapy may be a reasonable option for managing locally advanced primary breast cancer," they concluded, "especially for estrogen receptor-positive tumors." But they acknowledged that this may only be an option for "selected patients."

Nonetheless, they wrote, "the overall number of therapies needed [in the hormone therapy group] was less than that required in the multimodal therapy group." And they added that the patient should take into account the combined side effects of surgery, chemotherapy and radiotherapy when making her treatment decision.

SOURCE:
European Journal of Cancer, December 2001; 37(18): 2331-2338

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