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Background  In a significant proportion of metastatic breast cancer (MBC) patients whose tumour has progressed within 6 months of endocrine therapy ( de novo  resistance), it is generally believed that the chance of achieving clinical benefit (CB) with further endocrine therapy is minimal.    Methods  Data was retrieved from a prospectively updated database of metastatic breast cancer. Relevant data was exported to SPSS™ software for statistical analysis.    Results  In oestrogen receptor (ER) positive MBC patients with assessable disease, CB was achieved in 159 (71.3%) (1 st  line) patients. When these patients were put on further endocrine therapy, the CB rates were 63.2% (on 2 nd  line), 46.1% (on 3 rd  line) and 20% (on 4 th  line) with a median duration of response (DOR) in those with CB of 22, 12, 11 and 15 months respectively. The remaining 64(28.7%) patients had  de novo  resistance on 1 st  line endocrine therapy. Seventeen of these patients were treated with further endocrine therapy. The CB rates were 29.4% (on 2 nd  line) and 22.2% (on 3 rd  line) with a median DOR in those with CB of 22.7 months and 14 months respectively.    Conclusion  The chance of further endocrine response continues to decrease with each line of therapy, yet CB is still seen with reasonable duration even with a 4 th  line agent. In addition, further endocrine response, with long duration, can be seen in a significant proportion of patients who have developed  de novo  resistance to 1 st  line endocrine therapy. The use of further endocrine therapy should not be excluded under these circumstances.

"Resurrection of clinical efficacy" after resistance to endocrine therapy in metastatic breast cancer