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You are here: Home: BCU 4|2002: Program Supplement: Case 4
Miami Breast Cancer
Conference
Tumor Board Case 4: Kathy Miller, MD
A patient with ER+ visceral
metastases |
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| The patient is a 62-year-old woman
diagnosed 30 months ago with a 1.4 cm, stage I, ER-positive
breast cancer. She underwent a modified radical mastectomy
and had negative axillary nodes. She was treated with
tamoxifen. Now on tamoxifen, she develops mild back
pain. A chest X-ray reveals multiple pulmonary nodules;
the largest one is 2 cm. A CT reveals 3 small liver
lesions. FNA of a lung lesion confirms metastatic breast
cancer. She is asymptomatic. What is your suggested
treatment?
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There is considerable debate about the management of women with
ER-positive breast cancer metastatic to visceral organs. Most research
leaders recommend a trial of endocrine therapy, unless the patient
is extremely symptomatic. Another strategy is to start both chemotherapy
and endocrine therapy and discontinue the chemotherapy after the
patient has a response and continue the hormone therapy. This woman
was asymptomatic, and most of the audience favored using an aromatase
inhibitor. In fact, Dr Miller’s patient was treated with anastrozole
and had a two-year complete response to this treatment.
Mouridsen H et al. Superior efficacy of letrozole versus tamoxifen
as first-line therapy for postmenopausal women with advanced breast
cancer: Results of a phase III study of the International Letrozole
Breast Cancer Group. J Clin Oncol 2001;19(10):2596-606.
Abstract
Nabholtz JM et al. Anastrozole is superior to tamoxifen as
first-line therapy for advanced breast cancer in postmenopausal
women: Results of North American multicenter randomized trial. Arimidex
Study Group. J Clin Oncol 2000;18(22):3758-67. Abstract
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