2.50
Hdl Handle:
http://hdl.handle.net/10541/92038
Title:
The primary use of endocrine therapies.
Authors:
Howell, Anthony ( 0000-0002-3879-5991 ) ; Anderson, Elizabeth; Blamey, R; Clarke, Robert B; Dixon, J M; Dowsett, Mitch; Johnston, S R; Miller, W R; Nicholson, Robert I; Robertson, John F R
Abstract:
Primary endocrine therapy is potentially superior to primary chemotherapy in patients with ER-positive tumors. The ability to give endocrine therapy perioperatively may be a better test than chemotherapy of the hypothesis that the events accompanying surgery affect prognosis. However, a major problem in all studies of primary endocrine therapy is that there has been no clear experimental test of preoperative versus postoperative therapy. This is because the major thrust of treatment has been in the elderly with the purpose of determining whether surgery can be avoided altogether. The fact that in ER-positive tumors primary endocrine therapy is associated with similar response rates to chemotherapy make it an attractive therapy for older women. This is the group where adjuvant chemotherapy has not been adequately tested (> or = 70 years of age). In contradistinction, adjuvant endocrine therapy shows marked survival benefits in patients with ER-positive tumors in these age groups (Table 1). It appears likely that primary endocrine therapy will allow breast conservation and prognostic information as is seen with chemotherapy. A major question which requires answering is whether primary endocrine therapy will improve survival more than adjuvant therapy alone. Although ER status is a good marker of responsiveness, its specificity, in particular, is not optimal. The ability to assess the dynamic effects of primary endocrine therapy by sequential biopsy and measurement of biological responses to oestrogen deprivation may allow us to predict precisely the patients likely to benefit from treatment. This clinical scenario allows us to use other potentially useful assessments such as the non-invasive estimation of angiogenesis using quantitative imaging techniques of blood flow. The newer anti-estrogens and aromatase inhibitors appear ideally suited to primary therapy since they have rapid and profound inhibitory activities, few or no agonist effects, and low side effect profiles. A preoperative trial of Faslodex is planned by the EORTC and another with Arimidex is under consideration by the ATAC (Arimidex, tamoxifen and combined) Trialist Group (Fig. 7). The precise design of these studies will require considerable thought.
Affiliation:
CRC Department of Medical Oncology, Christie Hospital NHS Trust, Manchester, UK.
Citation:
The primary use of endocrine therapies. 1998, 152:227-44 Recent Results Cancer Res.
Journal:
Recent Results in Cancer Research.
Issue Date:
1998
URI:
http://hdl.handle.net/10541/92038
DOI:
10.1016/S0167-8140(98)00059-0
PubMed ID:
9928561
Language:
en
ISSN:
0080-0015
Appears in Collections:
All Christie Publications ; All Paterson Institute for Cancer Research

Full metadata record

DC FieldValue Language
dc.contributor.authorHowell, Anthonyen
dc.contributor.authorAnderson, Elizabethen
dc.contributor.authorBlamey, Ren
dc.contributor.authorClarke, Robert Ben
dc.contributor.authorDixon, J Men
dc.contributor.authorDowsett, Mitchen
dc.contributor.authorJohnston, S Ren
dc.contributor.authorMiller, W Ren
dc.contributor.authorNicholson, Robert Ien
dc.contributor.authorRobertson, John F Ren
dc.date.accessioned2010-02-12T16:17:48Z-
dc.date.available2010-02-12T16:17:48Z-
dc.date.issued1998-
dc.identifier.citationThe primary use of endocrine therapies. 1998, 152:227-44 Recent Results Cancer Res.en
dc.identifier.issn0080-0015-
dc.identifier.pmid9928561-
dc.identifier.doi10.1016/S0167-8140(98)00059-0-
dc.identifier.urihttp://hdl.handle.net/10541/92038-
dc.description.abstractPrimary endocrine therapy is potentially superior to primary chemotherapy in patients with ER-positive tumors. The ability to give endocrine therapy perioperatively may be a better test than chemotherapy of the hypothesis that the events accompanying surgery affect prognosis. However, a major problem in all studies of primary endocrine therapy is that there has been no clear experimental test of preoperative versus postoperative therapy. This is because the major thrust of treatment has been in the elderly with the purpose of determining whether surgery can be avoided altogether. The fact that in ER-positive tumors primary endocrine therapy is associated with similar response rates to chemotherapy make it an attractive therapy for older women. This is the group where adjuvant chemotherapy has not been adequately tested (> or = 70 years of age). In contradistinction, adjuvant endocrine therapy shows marked survival benefits in patients with ER-positive tumors in these age groups (Table 1). It appears likely that primary endocrine therapy will allow breast conservation and prognostic information as is seen with chemotherapy. A major question which requires answering is whether primary endocrine therapy will improve survival more than adjuvant therapy alone. Although ER status is a good marker of responsiveness, its specificity, in particular, is not optimal. The ability to assess the dynamic effects of primary endocrine therapy by sequential biopsy and measurement of biological responses to oestrogen deprivation may allow us to predict precisely the patients likely to benefit from treatment. This clinical scenario allows us to use other potentially useful assessments such as the non-invasive estimation of angiogenesis using quantitative imaging techniques of blood flow. The newer anti-estrogens and aromatase inhibitors appear ideally suited to primary therapy since they have rapid and profound inhibitory activities, few or no agonist effects, and low side effect profiles. A preoperative trial of Faslodex is planned by the EORTC and another with Arimidex is under consideration by the ATAC (Arimidex, tamoxifen and combined) Trialist Group (Fig. 7). The precise design of these studies will require considerable thought.en
dc.language.isoenen
dc.subjectBreast Canceren
dc.subject.meshAged-
dc.subject.meshAntineoplastic Agents, Hormonal-
dc.subject.meshBreast Neoplasms-
dc.subject.meshChemotherapy, Adjuvant-
dc.subject.meshFemale-
dc.subject.meshHumans-
dc.subject.meshPreoperative Care-
dc.subject.meshRandomized Controlled Trials as Topic-
dc.subject.meshReceptors, Estrogen-
dc.subject.meshSurvival Rate-
dc.subject.meshTamoxifen-
dc.titleThe primary use of endocrine therapies.en
dc.contributor.departmentCRC Department of Medical Oncology, Christie Hospital NHS Trust, Manchester, UK.en
dc.identifier.journalRecent Results in Cancer Research.en

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