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Differential response to chemotherapy in metastatic breast cancer in relation to estrogen receptor level. Results of a prospective randomized study
Author(s) -
Rosner Dutzu,
Lane Warren W.,
Nemoto Takuma
Publication year - 1989
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19890701)64:1<6::aid-cncr2820640103>3.0.co;2-l
Subject(s) - medicine , cyclophosphamide , chemotherapy , vincristine , regimen , breast cancer , estrogen receptor , methotrexate , metastatic breast cancer , prospective cohort study , prednisone , oncology , chemotherapy regimen , gastroenterology , fluorouracil , cancer
The predictive value of estrogen receptor (ER) level for response to chemotherapy was studied in 182 patients with metastatic breast cancer in a prospective study. Patients were stratified according to ER status and dominant site of disease and randomized to one of three regimens: cyclophosphamide, 5‐Fluorouracil, and prednisone (CFP) versus CFP, methotrexate, and vincristine (CFPMV) versus doxorubicin and cyclophosphamide (AC). There was no significant differences in all response categories ( P = 0.21), duration of remission ( P = 0.07), and survival ( P = 0.17) among the three regimens. When ER status was taken as a predictor for response to chemotherapy, there was no significant difference in overall response ( P = 0.61) between ER+ (62/108, 57%) and ER‐patients (31/49, 63%). However, there was a significant trend toward a higher degree of response in ER‐patients (more complete response [CR] nine of 49, 18%, and fewer failures six of 49, 12%) than in ER+ (less CR seven of 108, 7%, and more failures 37/108, 34%) ( P = 0.006). Patients with higher measured levels of ER showed worse response (Kendall's tau C, P = 0.026). This trend for ER– patients to have better response than ER+ patients was generally consistent, regardless of the predominant site of metastases or chemotherapy regimen ( P = 0.04 for CFP; P = 0.08 for CFPMV; and P = 0.20 for AC). The advantage of a better response for ER– patients was nullified by an earlier relapse which was reflected in longer duration of remission, time to treatment failure, and survival in favor of ER+ patients (12.3 months versus 7.3 months remission duration, 18.7 months versus 13.6 months survival in partial responders). These data suggest that ER– patients respond to a higher extent to chemotherapy but relapse sooner than ER+ patients, suggesting a more rapid growth for ER– tumors. In patients with ER– tumors and poorer prognosis on conventional chemotherapy, new trials of intensive consolidation after response should be considered.