Endocrine therapy of breast and prostate cancer

Breast cancer is a highly heterogeneous disorder with regard to biologic and clinical characteristics. Identification of patients with different biologic subtypes is important both prognostically and therapeutically. The recent introduction of estrogen and progesterone receptor measurement has considerably increased our ability to identify patients with hormone-dependent tumors who are likely to respond to endocrine therapy and enjoy a longer survival. Assessment of the tumor growth fraction by autoradiographic or flow cytometric methods and measurement of EGF receptors in tumor specimens are likely to produce additional independent information on the clinical outcome of patients with breast cancer. The endocrine therapy of breast cancer has been greatly facilitated with the introduction of newer forms of therapy such as antiestrogens and aromatase inhibitors. These forms of treatments are well established, not only in patients with metastatic disease but also in selected subgroups of women with operable breast cancer following surgery. In view of its low toxicity and ease of administration, modern endocrine therapy has obviated the need for major ablative procedures such as surgical adrenalectomy and hypophysectomy. Unfortunately, duration of response and survival have not been prolonged by these newer endocrine treatments when compared with traditional hormonal therapy. Thus, new treatment strategies need to be developed, since current therapy does not cure any patient with advanced disease and at best only a small fraction of women with early breast cancer. Hormonally induced manipulation of tumor cell kinetics may provide a tool to enhance the efficacy of cytotoxic chemotherapy, in both metastatic as well as locally advanced disease. This potential approach needs to be further evaluated in prospective randomized clinical trials. Prostate cancer is the male counterpart of hormone-dependent neoplasia. Conventional therapy of this malignancy consists of surgical or medical castration. However, despite a high initial response rate, disease progression invariably occurs with poor response to secondary forms of therapy. Potential new treatment strategies currently being tested in the attempt to improve clinical outcome include simultaneous early blockade of both adrenal and testicular androgens as well as hormonally induced tumor cell growth synchronization and recruitment prior to administration of cytotoxic chemotherapy.