ER+: forward or backward?

[Rich66]

Ok..
Mom is one of the few ER+ here (Her2 borderline) so I've been looking at all the various chemos and noticing, that in the main, ER- tumors are thought to have higher response rate to chemo.

Then I come across an old (albeit small) piece from the 1980 that seems to suggest a shift (or reversal) has happened along the way. I mean..89% response rate? Could it be that older regimens were/are actually more effective for ER+ w/mets? I suppose one factor could be that Cytoxan is oral and inherently somewhat metronomic. Go to the link and see the tables.


http://www3.interscience.wiley.com/cgi-bin/fulltext/112679448/PDFSTART


Estrogen Receptor Status and Response to Chemotherapy
in Advanced Breast Cancer
DAVID T. KIANG, MD, PHD, DANIEL H. FRENNING, MD, JULIETTE GAY, RN, ANNE I . GOLDMAN, PHD, AND
B. J. KENNEDY, MD
Tumor estrogen receptor status in women with advanced breast cancer was correlated with clinical
response to cytotoxic chemotherapy in a retrospective study. Following an extramural review of the clinical
data of 40 patients, 26 responded to chemotherapy (65%). The response rate in 19 receptor-richtumors was 89% and in 21 receptor-poor tumors, 43% (P < 0.01). The lowest response rate (14%) was
observed in seven postmenopausal patients with receptor-poor tumors. Clinical characteristics of
patients and variants in chemotherapy programs failed to explain the favorable response of receptor-rich
tumors to cytotoxic chemotherapy.
Cancer 46:2814-2817, 1980.

[StephN]

Would your Mom fall into the receptor-rich category? I am not sure what that means, as I think they had different ways of measuring the hormone positivity in those days.

Do you want your Mom to try cytoxin?

[Rich66]

Although she "failed" Arimidex in adjuvant, and her HER2 status is questionable, every biopsy(primary, surgery,liver met) shows her strongly ER+, somewhat PR+.
Just want her to use whatever makes sense. I would love to see a breakdown of the various chemos and responses based on receptor(s). It seems like ER/chemo discussions lump all the chemos together even though they are known to have different mechanisms. I always thought that was probably too simplistic. This old abstract seems to suggest there's more to it. I mean..89% response in any chemo is pretty amazing...even more so in ER+. It seems totally inverted relative to current thinking. Maybe it's just a lousy study and the results are worthless. But what if it's legit? Did the shift to different drugs over the years reduce the effectiveness of "chemo" in ER+? I notice Kerbel is using this drug a lot for metronomic (http://her2support.org/vbulletin/showthread.php?t=24729&highlight=fever+therapy) study. I figured it was just because it's available in oral form. It's just weird because it seems to be viewed as an outdated old school drug.
I am firmly in the camp of "whetever works". Some think different endocrine therapy is better in an ER+/her2 neg recurrence. But maybe that's because certain chemos aren't even looked at/studied anymore. Just don't want options ignored because they have become unfashionable.

When posting to Adrien's thread, I realized I am unaware of any ER+ mets gals getting to NED through chemo.