Neoadyuvant Hormonotherpy for Posmenopausics Women with Locallity Advanced Breast Cancer

• Novoa Vargas Arturo

  Oncology Surgeon, Tuxpan No. 29, 5º piso, Consultorio 516, Col. Roma Sur. CP: 06760, México City, México

Objective: Present display the objective respond, frequency complete clinical response and pathological complete response with the use of induction hormonotherapy in posmenopausic women with locally advanced breast cancer, (stages III).

Methods: Analysis ina Regional General Hospital of a State of Mexico, Mexico;80 patients with chanalicular infiltrate breast cancer. Positive hormonal receptors: estrogen and progesterone, inmunohistochemical study with Her2 and p53. Eligibles patients were treated in a prospective study, to double blind, using per os: letrozol, 2.5 mg; exemestan, 25 mg and anastrozol, 1 mg with aromatase inhibitors; tamoxifen, 20 mg; during 36 consecutive months. Reports were taken at the beginning, subsequent to 3 months and 6 months ago to evaluate the frequency of objective respond. Patients, whom did not show response to neoadjuvant therapy, became treatment with radiotherapy. Patients, whom showed complete or partial clinical respond, went candidates to radical mastectomy. It was used statistical method Chi 2, with p of Mantel-Haenzel table to evaluate differences.

Results: During a period of 3 years, january of the 2006 to january of the 2009, 4 groups of patients, 80 studied altogether; the age average was 66.5 years old, with a rank of 45 to 75 years with breast cancer, stages IIIA to IIIB, FIGO stages. Objective respond, OR=55%, 44 patients; Clinical respond, 32 patients (40%); ClR plus CPR, complete pathological respond, 12 patients (15%), p=0.05; Complete pathologicalrespond was founded in 12 patients (15%); 40% with aromatase inhibitors and with tamoxifén TMX, 15%, p=0.05. Without Clinical respond (<50% tumoral volume) in eleven patients: 5 patients; 25% in tamoxifen group and 19% in patients with aromatase inhibitors group, p=0.05. These patients over express the proteins HER2/neu and p53 were positive. Collateral effects used NA hormonotherapy with aromatase inhibitors was 23% and with the use of tamoxifen in 32% of the patients, p = 0.05. They didnt respond to neoadyuvant therapy with hormonal receptors <30%, 19% aromatase inhibitors patients; with anastrozol, 10%; with exemastane, 5%; with letrozol, 4% and 25% with tamoxifen; reason why, they received treatment with radiotherapy, because they didnt accept chemotherapy. All patients candidates to surgery were benefitted with the mastectomy surgery.

Conclusions: HTNA is a good therapeutic alternative in posmenopausic women with locally advanced breast cancer, whom didnt accept chemotherapy.

Work shows efficacy of the HTNA for identify patients with breast cancer and hormonal receptors positives, without over express the protein HER2 and p53, they have better survive prognosis and could be rescue with mastectomy.

Its a preliminary study shows there are significance difference in objective respond between aromatase inhibitors and tamoxifen treatments, used in NA form for patients with breast cancer stage III.

In future we will search objective respond between hormonotherapy and chemoterapy used in NA form, in posmenopausic patients.

Forbes JF. The control of breast cancer: the role of tamoxifen. Semin Oncol 1997; 24(Suppl 1): SI-5-19.

Ellis MJ, Coop A, Singh B, et al. Letrozole is more effective neoadyuvant endocrine therapy than tamoxifen for ErbB-1-and/or ErbB-2-positive, estrogen receptor - positive primary breast cancer: evidence from a phase III randomized trial. J Clin Oncol 2001; 19: 3808-16.

Novoa VA. Letrozole compared with tamoxifen as neoadjuvant therapy for locally advanced, in patients postmenopausal hormone-dependent breast cancer. GAMO 2010; 9(2): 12-17.

Put them TJ. Efficacy of tamoxifen as treatment of breast cancer. Semin Oncol 1997; 24(Suppl 1): Yes-48-54.

Tripathy D. Using neoadyuvant yherapy for breas cancer in clinical practice: when and how? Breast Cancer Res Treat 2012; 132: 775-77. http://dx.doi.org/10.1007/s10549-012-2030-8

Liu SV, Melstrom L, Yao K, et al. Neoadyuvant therapy for breast cancer. J Surg Oncol 2010; 101: 283-91. http://dx.doi.org/10.1002/jso.21446

Howell A. Antiestrogens: future prospects. Oncology 1997; 112(Suppl 1): 59-64.

Litherland S, Jackson IM. Antioestrogens in the management of hormone-dependent cancer. Cancer Treat Rev 1988; 15: 183-94. http://dx.doi.org/10.1016/0305-7372(88)90002-3

Put them TJ. Efficacy of tamoxifen as treatment of breast cancer. Semin Oncol 1997; 24(Suppl 1): Yes-48-54.

Chlebowski RT, necklace, Somerfield MR et to the. American Society of Clinical Oncology technology assessment on breast cancer risk reduction strategies: tamoxifen and raloxifene. J Clin Oncol 1999; 17: 1939-55.

Fisher B, Constantino JP, Wicheham DL, Cecchini RS, et al. Tamoxifen for the prevention of breast cancer: Current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study. J Natl Cancer Inst 2005; 97: 1652-62. http://dx.doi.org/10.1093/jnci/dji372

Beattie MS, Constantino JP, Cummings SR, Wickehman DL, et al. Endogenous sex hormones, breast cancer risk, and tamoxifen response: an ancillary study in the NSABP breast cancer prevention Trial (P-1). J Natl Cancer Inst 2006; 98: 110-15. http://dx.doi.org/10.1093/jnci/djj011

Lewis CI, Kinsinger LS, Russell P, Harris MP, et al. Breast cancer risk in primary care. Implications for chemoprevention. Arch Intern Med 2004; 164: 1897-903. http://dx.doi.org/10.1001/archinte.164.17.1897

Tobias JS. Recent advances in endocrine therapy for postmenopausal women with early breast cancer: Implications for treatment and prevention. Ann Oncol 2004; 15: 1738-47. http://dx.doi.org/10.1093/annonc/mdh485

Cuzick J. Aromatase inhibitors in prevention-data from the ATAC (Arimidex, Tamoxifen Alone or in Combination) trial and the design of IBIS-II (the second International Breast Cancer Intervention Study). Recent Results Cancer Res 2003; 163: 96-103, 264-266. http://dx.doi.org/10.1007/978-3-642-55647-0_9

Goss PE, Strasser-Weippl K. Prevention strategies with aromatase inhibitors. Clin Cancer Res 2004; 10: 372-79. http://dx.doi.org/10.1158/1078-0432.CCR-031210

Klijn JG, Morlock RW, Boccardo F, et al. Combined tamoxifen and luteinizing hormone-releasing hormone (LHRH) agonist versus LHRH agonist along in premenopausal advanced breast cancer: a metaanalysis of four randomised trials. Cl J Oncol 2001; 19: 343-53.

Dowsett M. the biology of steroid hormones and endocrine therapies. Breast 2005; 14(Suppl): S5. http://dx.doi.org/10.1016/S0960-9776(05)80010-4

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