Cancer, breast endocrine treatment

Henningsen B, Linder F, and Steichele C (eds.) (1980) Recent Results in Cancer Research, Endocrine Treatment of Breast Cancer A New Approach. Berlin Springer-Verlag. 

Buzdar A, Hayes D, El Khoudary A, Yan S, Lonning P, Lichinitser M, et al. (2002) Phase III randomized trial of droloxifene and tamoxifen as first-line endocrine treatment of ER/Pg-positive advanced breast cancer. Breast Cancer Res Treat 73 161-175... 

Howell A, Robertson JF, Quaresma AJ, Aschermannova A, Mauriac L, Kleeberg UR, Vergote I, Erikstein B, Webster A, Morris C (2002) Fulvestrant, formerly ICI 182,780, is as effective as anastrozole in postmenopausal women with advanced breast cancer progressing after prior endocrine treatment. J Clin Oncol 20 3396-3403... 

Robertson JFR, Come SE, Jones SE, Beex L, Kaufmann M, Makris A, Nortier JWR, Possinger K, Rutqvist LE (2005) Endocrine treatment options for advanced breast cancer - the role of fulvestrant Eur J Cancer 41 346-356... 

There are now two main groups of patients to consider when sequencing endocrine treatment in breast cancer those who progressed on or after adjuvant or first-line advanced tamoxifen treatment, and those who progressed on or after adjuvant or first-line advanced AI treatment. There is a need for treatments that are effective and that are not cross-resistent with tamoxifen or AIs. 

Rubens RD, Bartelink H, Engelsman E, et al. Locally advanced breast cancer the contribution of cytotoxic and endocrine treatment to radiotherapy. An EORTC Breast Cancer Co-operative Group Trial (10792). EurJ Cancer Clin Oncol 1989 25 667-678. 

Tamoxifen versus aromatase inhibitors While tamoxifen is still widely regarded as the standard adjuvant endocrine treatment for postmenopausal women with localized breast cancer, provided it is hormone receptor positive, there are problems with recurrence and adverse effects. Reservations have recently been expressed about the future place of tamoxifen, and the case has been made that it is time to move from tamoxifen to the oral aromatase inhibitors (19). 

In a prospective study in 77 consecutive women with postmenopausal breast cancer scheduled to start endocrine treatment for breast cancer, using either tamoxifen or an aromatase inhibitor tamoxifen treatment significantly increased endometrial thickness and uterine volume after 3 months (24). In additional, tamoxifen induced endometrial cysts and polyps and increased the size of pre-existing fibroids. In contrast, aromatase inhibitors did not stimulate endometrial growth and were not associated with endometrial pathology. Furthermore, they reduced endometrial thickness and uterine volume in patients who had previously taken tamoxifen. 

Mathew J et al (2009) Neoadjuvant endocrine treatment in primary breast cancer - review of literature. Breast 18 339-344... 

Tobias, J.S. 2004. Recent advances in endocrine therapy for postmenopausal women with early breast cancer implications for treatment and prevention. Ann. Oncol. 15, 1738-1747. 

Buzdar, A., Hayes, D., El-Khoudary, A., Yan, S., Learning, P., Lichinitser, M., Gopal, R., Falkson, G., Pritchard, K., Lipton, A., Wolter, K., Lee, A., Fly K., Chew, R., Alderdice, M., Burke, K. and Eisenherg, P. (2002) Phase III randomized trial of droloxifene and tamoxifen as first-line endocrine treatment of ER/PgR-positive advanced breast cancer. Breast Cancer Research and Treatment, 73, 161-175. 

Dowsett, M., Nicholson, R.I. and Pietras, R.J. (2005) Biological characteristics of the pure antiestrogen fulvestrant overcoming endocrine resistance. Breast Cancer Research and Treatment, 93 (Suppl 4), 11—18. 

This P, Magdelenat H. Phytoestrogens and adjuvant endocrine treatment of breast cancer. J Clin Oncol 2000 18 2792. 

Herrriksen, K., Rasmussen, B., Lykkesfeldt, A. et al. (2007) Semi-quantitative scoring of potentially predictive markers for endocrine treatment of breast cancer a comparison between whole sections and tissue microarrays. J Clin Pathol, 60, 397—404. 

The goal of therapy with early and locally advanced breast cancer is to cure the disease. Breast cancer is currently incurable after it has advanced beyond local-regional disease. The goal of treatment of metastatic breast cancer is to improve symptoms, maintain quality of life, and extend survival. Thus it is important to choose therapy with good activity while minimizing toxicities. Treatment of metastatic breast cancer with either cytotoxic or endocrine therapy often results in regression of disease and improvements in quality of life. 

Finally, therapeutic sequencing of different hormonal agents is fast becoming a common clinical practice, and fulvestrant is a good treatment choice to extend the opportunity for using endocrine therapies before reliance upon cytotoxic chemotherapy is necessary. Further research is required in order to evaluate the optimal sequence, both in clinical practice as well as in the laboratory, to choose the correct treatment of breast cancer in each person after the appearance of tamoxifen-induced drug resistance (Robertson 2004 Osipo et al. 2004 Johnston 2004 Robertson et al. 2005). 

Howell A, Robertson JFR, Abram P, Lichinitser MR, Elledge R, Bajetta E, Watanabe T, Morris C, Webster A, Dimery I, et al. (2004a) Comparison of fulvestrant versus tamoxifen for the treatment of advanced breast cancer in postmenopausal women previously untreated with endocrine therapy a multinational, double-blind, randomized trial. J Clin Oncol 22 1605-1613... 

In this chapter we will review the basic aspects of endocrine regulation of breast tissue growth and development. The relationship between genetics, estrogen exposure, and breast cancer risk will be discussed, and preclinical and clinical experience in the use of SERMS for both prevention and adjuvant treatment of ER-positive breast cancer will be reviewed and put in perspective. 

Q79 Tamoxifen is an oestrogen-receptor antagonist that is only effective as adjuvant endocrine therapy of early breast cancer in postmenopausal v/omen. Tamoxifen is given by mouth and treatment should not exceed 1 year. 

In addition, it will be our intention to present a deeper insight into the biosynthesis of steroid hormones, which will allow definition of new targets and approaches for the treatment of endocrine-responsive cancer. Enzymes involved in mechanisms of steroid hormone biosynthesis might be novel targets for endocrine therapy. Moreover, further therapeutic indications for modulators of steroid hormone receptors will be discussed. In summary, many promising new opportunities for endocrine therapy of breast and prostate cancer are now arising. 

Lonning PE, Taylor PD, Anker G, Iddon J, Wie L, Jorgensen LM, Mella O, Howell A. High-dose estrogen treatment in postmenopausal breast cancer patients heavily exposed to endocrine therapy. Breast Cancer Res Treat 2001 67(2) 111—6. 

Dardes RC, Jordan VC. Future directions in endocrine therapy for the treatment and prevention of breast cancer. Sem Breast Dis 2000 3 119-30. 

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