Am J Clin Oncol. 2009 Aug 28. [Epub ahead of print]
Exemestane as First-Line Therapy in Postmenopausal Women With Recurrent or Metastatic Breast Cancer.
Glück S.
From the Division of Hematology/Oncology, Department of Medicine, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, Florida.
Antiestrogen therapies generally offer significant disease control to hormone receptor-positive recurrent or metastatic breast cancer patients and are substantially better tolerated than standard chemotherapy regimens, thus representing an attractive first treatment option.
The steroidal aromatase inhibitor (AI) exemestane exhibits antitumor effects by lowering full-body estrogen production in postmenopausal women and is an established treatment option for metastatic breast cancer. We review data from 2 recent phase III clinical trials that have confirmed exemestane activity in the first-line metastatic breast cancer setting, with moderate improvements in median progression-free survival (10-12 months) and objective response rates (37%-46%) compared with tamoxifen.
The activity of first-line exemestane is comparable with other antiestrogen therapies, including fulvestrant and the nonsteroidal AIs letrozole and anastrozole. Additional findings demonstrating the clinical benefits of exemestane in women who previously progressed on nonsteroidal AIs highlight a partial lack of cross-resistance between these therapies and reinforce the opportunity to use multiple antiestrogen treatments sequentially. Future therapeutic developments in hormone receptor-positive metastatic breast cancer could include combinations with other targeted compounds plus AIs or other antiestrogen-based combinations and the identification of new strategies to evaluate differences among antiestrogen therapies to help optimize the treatment sequence and potential combinations.
PMID: 19730353 [PubMed - as supplied by publisher]
Gan To Kagaku Ryoho. 2009 Dec;36(13):2623-5.
[A case of recurrent breast cancer with extensive liver metastasis successfully treated with endocrine therapy]
[Article in Japanese]
Kiyoto S,
Hara F,
Osumi S,
Takabatake D,
Takashima S,
Aogi K,
Takashima S.
Dept. of Breast Oncology, Shikoku Cancer Center.
A 5 6-year-old woman, who underwent breast-conserving surgery and radiation (60 Gy) therapy in July, 1992, at the age of 40, was diagnosed with pT1aN0M0, pStage I. She was administered tamoxifen (TAM) as adjuvant therapy. However, she underwent microdochectomy for DCIS in her contralateral breast in June, 1998. TAM was given till August, 1999. In June, 2006, at the age of 54, 14 years after initial surgery, CT revealed extensive liver masses which were diagnosed as liver metastasis by liver biopsy. Receptor status was positive for ER and PgR, and negative for HER2.
AC was started as a first-line chemotherapy ( 4 courses), but did not prove effective. She refused second-line chemotherapy, so letrozole was selected, and subsequently resulted in PR of the liver metastasis. However, 8 months later, with a liver metastasis relapse, exemestane followed by tamoxifen, medroxyprogesterone acetate, and high-dose toremifene were administered sequentially, resulting in long-time disease control. In conclusion,
endocrine therapy might be an effective option even in a visceral crisis, if metastatic tumors have showed slow growth and there is positive hormone receptor status.
PMID: 20009467 [PubMed - in process]
Linear Mode
