Endocrine Therapy Better Than Chemo? ER+

SABCS: Endocrine Therapy A Better Choice for Estrogen-Positive Tumors? 1. By Charlene Laino

SAN ANTONIO, TX -- December 8, 2003 -- Patients with estrogen-receptor-positive breast cancer may benefit more from an initial treatment of endocrine therapy than from chemotherapy, say researchers who found that pathological complete response rates after anthracycline with or without taxane therapy were higher in patients with estrogen-receptor-negative tumors than those with estrogen-receptor-positive disease.

The findings were presented here on December 4th at the 26th Annual San Antonio Breast Cancer Symposium by Aman Buzdar, MD, professor, Department of Breast Medical Oncology, University of Texas, M.D. Anderson Cancer Center, Houston, Texas, United States.

For the retrospective study, the researchers looked at 1,018 patients followed at the center since 1975 in which the estrogen-receptor status of their tumor samples was known. All patients received anthracycline-based therapies with or without paclitaxel or docetaxel, plus surgery.

The study showed that patients with estrogen-receptor-positive disease had pathological complete response rates that were significantly lower, regardless of drug regimen or duration of chemotherapy (P < .001).

Specifically, 20.6% of patients with estrogen-negative breast cancer had a complete pathologic response, compared with 5% of those with estrogen-positive cancer.

"The important thing is, in estrogen-receptor-negative patients, you are much more likely to get a pathological complete response -- that is, no invasive cancer in either [the] breast or in the lymph nodes," Dr. Buzdar said in an interview.

"That opens the question of whether estrogen-receptor-positive patients should be treated differently. It appears that endocrine therapy in the adjuvant setting is better than chemotherapy for estrogen-receptor-positive patients."

Estrogen-negative cancers are more poorly differentiated, and tend to be more sensitive to chemotherapy drugs, he added. Estrogen-receptor-positive breast cancers are more differentiated, and tend to be less responsive to chemotherapy.

Dr. Buzdar called for randomized trials pitting chemotherapy against endocrine therapy for the treatment of patients with estrogen-receptor-positive breast cancers in the adjuvant setting.

[Study Title: Pathological Complete Response to Chemotherapy is Related to Hormone Receptor Status. Abstract 302]


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