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Can Endocrine Treatment for Hormone-Positive Premenopausal Women With Early Breast Cancer Replace Adjuvant Chemotherapy?

Iran University Medical School, Tehran, Iran

To the Editor:

In the December 15, 2002 issue of the Journal of Clinical Oncology, Jakesz et al¹ and Jonat et al² tried to determine the best postoperative treatment for hormone-receptor–positive premenopausal women with early breast cancer. Jakesz et al showed that a complete endocrine blockade with 3 years of receiving gosorelin and 5 years receiving tamoxifen was more effective than chemotherapy with cyclophosphamide, methotrexate, and fluorouracil (CMF). Relapse-free survival and local recurrence-free survival were significantly in favor of the endocrine therapy, and there was a trend in favor of the endocrine treatment for overall survival, but this was not statistically significant.

Jonat et al compared 2 years of receiving gosorelin with adjuvant CMF therapy. Disease-free survival was identical for patients with estrogen-receptor–positive tumors.

Both studies were well performed, but neither group mentioned the neu/erbB-2 overexpression in their series. They both used CMF chemotherapy as their control arm. While some studies have shown that neu/erbB-2 overexpression is associated with less benefit from CMF chemotherapy,^3,4 the overexpression of neu/erbB-2 has also been shown to be associated with relative resistance to hormone therapies.^5,6 There is, however, some discrepancy in other reports on the overexpression of this predictive marker and response to endocrine treatment.⁷ An uneven distribution of neu/erbB-2 overexpression might have influenced the outcomes of both studies.

Predictive markers such as neu/erbB-2 overexpression should be included in the analysis in order to optimize treatment for this group of patients.

It can be concluded that optimal postoperative treatment of premenopausal-hormone-receptor–positive patients will remain an open issue, and the treatment of choice is inclusion in large randomized trials.

REFERENCES

1. Jakesz R, Hausmaninger H, Kubista E, et al: Randomized adjuvant trial of tamoxifen and goserelin versus cyclophosphamide, methotrexate, and fluorouracil: Evidence for the superiority of treatment with endocrine blockade in premenopausal patients with hormone-responsive breast cancer—Austrian Breast and Colorectal Cancer Study Group trial 5. J Clin Oncol 20:4621–4627, 2002[Abstract/Free Full Text]

2. Jonat W, Kaufmann M, Sauerbrei W, et al: Goserelin versus cyclophosphamide, methotrexate, and fluorouracil as adjuvant therapy in premenopausal patients with node-positive breast cancer: The Zoladex Early Breast Cancer Research Association Study. J Clin Oncol 20:4628–4635, 2002[Abstract/Free Full Text]

3. Gusterson BA, Gelber RD, Goldhirsch A, et al: Prognostic importance of c-erbB-2 expression in breast cancer: International (Ludwig) Breast Cancer Study Group. J Clin Oncol 10:1049–1056, 1992[Abstract]

4. Allred DC, Clark GM, Tandon AK, et al: HER-2/neu in node-negative breast cancer: Prognostic significance of overexpression influenced by the presence of in situ carcinoma. J Clin Oncol 10:599–605, 1992[Abstract/Free Full Text]

5. Leitzel K, Teramoto Y, Konrad K, et al: Elevated serum c-erbB-2 antigen levels and decreased response to hormone therapy of breast cancer. J Clin Oncol 13:1129–1135, 1995[Abstract]

6. Yamauchi H, O’Neill A, Gelman R, et al: Prediction of response to antiestrogen therapy in advanced breast cancer patients by pretreatment circulating levels of extracellular domain of the HER-2/c-neu protein. J Clin Oncol 15:2518–2525, 1997[Abstract/Free Full Text]

7. Elledge RM, Green S, Ciocca D, et al: HER-2 expression and response to tamoxifen in estrogen receptor-positive breast cancer: A Southwest Oncology Group Study. Clin Cancer Res 4:7–12, 1998[Abstract]

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This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Malayeri, R. Search for Related Content PubMed PubMed Citation Articles by Malayeri, R. Social Bookmarking                            What's this?