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Superiority of Letrozole Over Tamoxifen in the First-Line Treatment of Metastatic Breast Cancer Patients With Normal Serum HER-2/neu Levels: Question of Tamoxifen Resistance

¹ Department of Medical Oncology, Hacettepe University Institute of Oncology
² Numune Education and Research Hospital, Ankara, Turkey

To the Editor: In the May 15, 2003 issue of the Journal of Clinical Oncology, Lipton et al¹ reported that patients with normal serum HER-2/neu receiving letrozole demonstrated a significantly greater objective response rate and clinical benefit and longer time-to-progression and time-to-treatment failure than patients receiving tamoxifen. In this prospective study, disease characteristics were almost equal in two arms. Although most of the patients (66% in letrozole arm; 67% in tamoxifen arm) were estrogen receptor-positive and/or progesterone receptor-positive, why did only 18% to 20% of the patients receive anti-estrogen therapy as adjuvant treatment? Although the patients whose disease relapsed after 12 months of completing adjuvant anti-estrogen therapy were included in the study, the tamoxifen resistance for these patients was always questionable when a comparison was made between letrozole and tamoxifen in a metastatic breast cancer setting. There was no consensus about when the patient who received adjuvant tamoxifen treatment can again receive tamoxifen in the first-line treatment of metastatic breast cancer. Tumor biology of breast cancer is so heterogeneous that some patients may develop tamoxifen resistance less than 1 year or over 1 year after treatment. This may cause a bias in evaluating the response of letrozole versus tamoxifen in patients who received tamoxifen as adjuvant treatment.

AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The authors indicated no potential conflicts of interest.

REFERENCE

1. Lipton A, Ali SM, Leitzel K, et al: Serum HER-2/neu and response to the aromatase inhibitor letrozole versus tamoxifen. J Clin Oncol 21:1967–1972, 2003[Abstract/Free Full Text]

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