PMID- 20110046
OWN - NLM
STAT- MEDLINE
DCOM- 20100218
LR  - 20210108
IS  - 1879-114X (Electronic)
IS  - 0149-2918 (Linking)
VI  - 31 Pt 2
DP  - 2009
TI  - High-dose estrogen as salvage hormonal therapy for highly refractory metastatic 
      breast cancer: a retrospective chart review.
PG  - 2371-8
LID - 10.1016/j.clinthera.2009.11.002 [doi]
AB  - BACKGROUND: High-dose estrogens (HDEs) are an efficacious but widely overlooked 
      treatment option for patients with metastatic breast cancer (MBC). This is due in 
      part to the introduction of tamoxifen in the 1970s, which was proven to be 
      equivalent in efficacy and associated with fewer adverse events (AEs). OBJECTIVE: 
      The aim of this study was to report our experience with the use of HDE in 
      postmenopausal women with advanced breast cancer. METHODS: Local institutional 
      review board approval was obtained to conduct a retrospective chart review of 
      patients with MBC treated with HDEs at the Boca Raton Comprehensive Cancer 
      Center, Boca Raton, Florida, from 2001 through March 2009. Demographic 
      information, response rates, and tolerability profiles were collected. RESULTS: 
      Of the 426 patients with MBC identified, we found 26 patients with MBC who were 
      prescribed HDEs as a treatment in any line of therapy for advanced breast cancer. 
      The median age at the start of HDE therapy was 59 years (range, 42-92 years). 
      Three of the 26 patients (11.5%) were human epidermal growth factor receptor 
      2-positive determined via fluorescent in situ hybridization analysis. With the 
      exception of 1 patient who had received no prior systemic treatment for 
      metastatic disease, all patients received multiple lines of treatment (both 
      chemotherapy and hormonal treatments) in the advanced setting (median, 7 lines; 
      range, 0-12) prior to the initiation of HDE. Five of 20 patients (25%) with 
      measurable metastatic disease (visceral and/or soft tissue metastases) had 
      objective antitumor responses defined as either a partial response (PR) or a 
      complete response (CR). Four additional patients (20%) had prolonged stable 
      disease (SD) for > or =6 months. Three of 6 patients (50%) with nonmeasurable 
      metastatic disease (bone-only) had prolonged SD for > or =6 months. Clinical 
      benefit rate (defined as CR + PR + SD > or =6 months) for all patients was 46% 
      (12/26), with a median duration of 10 months. Overall median progression-free 
      survival for the 26 subjects was 5 months. Median survival from the start of HDE 
      was 17 months (range, 3-54 months). AEs included fluid retention (8 [31%]), 
      vaginal bleeding (7 [27%]), and nausea (4 [15%]). Two patients discontinued 
      therapy after 1 month. Three of the remaining 24 patients discontinued estrogen 
      therapy due to AEs. CONCLUSIONS: This retrospective chart review details our 
      facility's experience with the use of HDE in patients with advanced breast 
      cancer, most of whom had received multiple prior treatments. Our data suggest 
      that this treatment is another option for heavily-treated patients in whom 
      further endocrine manipulation might still be appropriate.
CI  - Copyright 2009 Excerpta Medica Inc. All rights reserved.
FAU - Mahtani, Reshma L
AU  - Mahtani RL
AD  - Boca Raton Comprehensive Cancer Center, Boca Raton, Florida 33428, USA. 
      rmahtani@aptiumoncology.com
FAU - Stein, Alisha
AU  - Stein A
FAU - Vogel, Charles L
AU  - Vogel CL
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Clin Ther
JT  - Clinical therapeutics
JID - 7706726
RN  - 0 (Antineoplastic Agents, Hormonal)
RN  - 0 (Estrogens)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Antineoplastic Agents, Hormonal/administration & dosage/adverse 
      effects/*therapeutic use
MH  - Breast Neoplasms/*drug therapy/pathology
MH  - Drug Administration Schedule
MH  - *Drug Resistance, Neoplasm
MH  - Estrogens/administration & dosage/adverse effects/*therapeutic use
MH  - Female
MH  - Humans
MH  - Middle Aged
MH  - Neoplasm Metastasis
MH  - Postmenopause
MH  - Retrospective Studies
MH  - *Salvage Therapy
MH  - Treatment Outcome
EDAT- 2010/01/30 06:00
MHDA- 2010/02/19 06:00
CRDT- 2010/01/30 06:00
PHST- 2009/09/24 00:00 [accepted]
PHST- 2010/01/30 06:00 [entrez]
PHST- 2010/01/30 06:00 [pubmed]
PHST- 2010/02/19 06:00 [medline]
AID - S0149-2918(09)00392-0 [pii]
AID - 10.1016/j.clinthera.2009.11.002 [doi]
PST - ppublish
SO  - Clin Ther. 2009;31 Pt 2:2371-8. doi: 10.1016/j.clinthera.2009.11.002.