Aminoglutethimide in tamoxifen-resistant patients: The Melbourne Experience

A group of 160 women with actively progressing metastatic breast cancer were treated with aminoglutethimide to induce medical adrenalectomy. The degree of adrenal suppression was monitored by measurement of dehydroepiandrosterone sulfate levels, and classification of response was carried out according to UICC criteria by two observers. Assessment of response is available for 136 patients, and of these 50 (36.7%) had an objective remission. In an additional 10 patients, the disease became static. Mean remission duration is 12.5 months (range, 4 to 30). Forty-one patients had previously remitted to tamoxifen and then relapsed, and of these 22 (53.6%) experienced another remission with aminoglutethimide. Fifty patients had failed to respond to tamoxifen, and of these 16 (32%) had a remission with aminoglutethimide. In the 20 patients who did not receive tamoxifen and in the 25 whose response to it could not be classified, the remission rates to aminoglutethimide were 25 and 28%, respectively. The high remission rate to medical adrenalectomy in patients who have previously responded to tamoxifen makes it the treatment of choice in tamoxifen-responsive patients.