[Aminoglutethimide therapy in advanced breast cancer]

45 women (postmenopausal or after former oophorectomy) with metastatic breast cancer resistant to tamoxifen as well as to chemo- and radiotherapy were treated with aminoglutethimide (750 mg or 1000 mg resp. daily) and hydrocortisone (40 mg daily). Treatment resulted in 33% remissions (2 CR + 13 PR) and 53% stabilizations (24 patients) besides a non-responder rate of 13% (6 patients). Side effects (mainly central sedation, possibly exanthema, seldom anorexia, but no hematotoxicity) were observed in 13 patients (29%). Duration of remission lasted for 1 to 24 months (mean duration 10,5 months) while stabilization extended for 2 to 17 months (mean duration 7,7 months). Mechanism of action by enzymatic inhibition of the adrenal steroid hormone synthesis ("medical adrenalectomy") as well as by extra-adrenal diminution of estrogens is considered in detail. Aminoglutethimide provides effective treatment in patients with generalized metastatic breast cancer followed by best outcome in cases with osseous metastases. Clinical results are presented as an approach to successful therapy of advanced breast cancer and an endocrine alternative in tamoxifen resistance as well as a therapeutic possibility in cytotoxic induced pancytopenia.