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Management of choroidal metastases from breast carcinomas using aromatase inhibitors
Maria E Manquez1, Melissa M Brown, Carol L Shields
1Oncology Service, Wills Eye Hospital, Thomas-Jefferson University, University of Pennsylvania, Philadelphia, Pennsylvania 19107, USA. m_manquez@yahoo.com
Purpose Of Review:
The outcome of patients diagnosed with uveal metastases from breast carcinoma, all of whom were treated with one of the new generation of hormone therapies named aromatase inhibitors, is reported.
Recent Findings:
Charts of all patients with uveal metastases from breast cancer seen at Wills Eye Hospital between 1995 and 2005 are reviewed. Seventeen patients were diagnosed with uveal metastases from estrogen-receptor-positive breast cancer and subsequently treated with one of the aromatase inhibitors (anastrozole, letrozole, exemestane).
Summary:
The interval between initial diagnosis of breast cancer and choroidal metastases ranged from 1 month to 17 years. Thirteen patients had received tamoxifen either at the time of breast surgery or as part of the metastases treatment. In 10 cases, both the systemic and choroidal metastases remained regressed over a mean of 20 months follow-up (4-50 months). There was no toxicity or intolerance to the medication. Aromatase inhibitors represent a new generation of hormone therapy for metastatic breast cancer. They were effective in 59% of the patients with estrogen-receptor-positive breast cancer, many of them nonresponding to prior treatment with tamoxifen. Aromatase inhibitors avoid the need for external beam radiation therapy as a treatment for the ocular metastases.
Insights
Aromatase inhibitors effectively treated uveal metastases in estrogen-receptor-positive breast cancer patients, even those resistant to tamoxifen. This hormone therapy offers a new treatment option, avoiding radiation for ocular metastases.
Area of Science:
- Oncology
- Ophthalmology
- Endocrinology
Background:
- Uveal metastases from breast cancer present a significant clinical challenge.
- Estrogen-receptor-positive breast cancer is a common subtype.
- Hormone therapies are crucial in managing metastatic breast cancer.
Purpose of the Study:
- To report the outcomes of patients with uveal metastases from breast carcinoma treated with aromatase inhibitors.
- To evaluate the efficacy and safety of new-generation hormone therapies in this patient population.
Main Methods:
- Retrospective review of patient charts from Wills Eye Hospital (1995-2005).
- Inclusion criteria: patients with uveal metastases from breast cancer treated with aromatase inhibitors (anastrozole, letrozole, exemestane).
- Analysis of treatment response, duration of regression, and toxicity.
Main Results:
- Seventeen patients with estrogen-receptor-positive breast cancer and uveal metastases were identified.
- Aromatase inhibitors showed effectiveness in 59% of patients.
- Mean follow-up of 20 months showed sustained regression of both systemic and choroidal metastases in 10 cases.
- No significant toxicity or intolerance to aromatase inhibitors was observed.
Conclusions:
- Aromatase inhibitors are an effective new-generation hormone therapy for metastatic breast cancer with uveal involvement.
- This treatment was successful in patients resistant to prior tamoxifen therapy.
- Aromatase inhibitors provide an alternative to external beam radiation therapy for ocular metastases.
