DES-ja vu

Prior to the use of antiestrogens, high dose estrogen therapy was widely used as effective therapy for breast cancer. The introduction of antiestrogens with their reduced toxicity profile greatly minimized subsequent use of estrogen to treat metastatic breast cancer. We administered diethylstilbestrol (DES), a nonsteroidal synthetic estrogen, to eight postmenopausal women with advanced breast cancer who had been heavily pretreated with hormones and cytotoxic chemotherapy. We report on response rates and toxicities related to this form of hormonal therapy. Eight postmenopausal women aged 53 to 79 years with progressive metastatic breast cancer were treated. All had been pretreated with 3 to 6 hormonal agents including an antiestrogen, a progestin and an aromatase inhibitor; 6 of the 8 patients had received treatment with 2 or 3 combinations of cytotoxic agents. All patients received diethylstilbestrol 5 mg orally three times daily until evidence of disease progression or significant toxicity. Four women (50%) showed objective responses, two (25%) had stable disease and two (25%) had progressive disease. Measurable responses included a complete and partial response and two minor responses. The duration of the responses were 12, 11, 6, and 3 months. The hormone was well-tolerated. High-dose estrogen is effective and safe therapy for breast cancer patients even when they are heavily pretreated with prior chemotherapy and hormonal therapy. High dose estrogen could be re-introduced into this clinical setting as effective therapy with an acceptable toxicity profile.