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The use of endocrine therapy
K I Pritchard1, D J Sutherland
1Division of Medical Oncology, Toronto-Bayview Regional Cancer Centre, Ontario, Canada.
Hematology/Oncology Clinics of North America
|December 1, 1989
Summary
Endocrine therapy benefits about one-third of metastatic breast cancer patients, offering a less toxic treatment option than chemotherapy. Optimizing drug sequencing and minimizing side effects are key to maximizing patient benefit from these hormonal treatments.
Area of Science:
- Oncology
- Endocrinology
Background:
- Endocrine therapy is a primary treatment for metastatic breast cancer.
- Approximately one-third of patients experience a positive response to endocrine therapy.
- Endocrine therapies are generally less toxic than chemotherapy.
Purpose of the Study:
- To review the efficacy and toxicity of various endocrine therapies for metastatic breast cancer.
- To discuss the optimal sequencing and combination of endocrine treatments.
- To highlight newer experimental endocrine agents and their potential role.
Main Methods:
- Review of existing literature on endocrine therapy for metastatic breast cancer.
- Analysis of response rates and toxicity profiles of different endocrine agents.
- Evaluation of combination therapies, including endocrine-endocrine and endocrine-chemotherapy combinations.
Main Results:
- Consistent response rates (around 33%) observed across various endocrine approaches.
- Lower response rates noted for corticosteroids, androgens, and danazol.
- Newer agents like antiestrogens and aminoglutethimide offer less toxic options.
- Experimental agents (LHRH agonists, antiandrogens) are under investigation.
- No clear advantage shown for concurrent chemotherapy-endocrine combinations or multiple concurrent hormonal agents, except possibly prednisolone with tamoxifen or oophorectomy.
Conclusions:
- Endocrine therapy remains a cornerstone in metastatic breast cancer treatment.
- Careful selection and sequencing of endocrine agents are crucial for maximizing benefit and minimizing toxicity.
- While combinations are under investigation, evidence for their superiority is limited, with some exceptions.