Interview
with Neil Love, MD Breast Cancer Update for Medical Oncologists,
Program 6 2000
Play
Audio Below:
The
new evidence — actually, the 1995 evidence, which is even clearer
in the year 2000 — is that there’s some areas where tamoxifen
really would be effective, where it’s still being underused.
And the chief one is younger women.
The
fact is that tamoxifen, if you had a young woman with receptor-positive
disease or an older woman with receptor-positive disease, the benefits
of tamoxifen are about the same, and they’re really quite substantial.
Now,
if you’re producing an absolute difference of say 10 or 15
percent in the risk of recurrence — if you’re changing,
say, a 40 percent risk of recurrence into a 30 percent risk or 25
percent risk — and this is long-term outcome — then doing
this for a younger woman is actually more important than doing it
for an older woman, because that young woman, if she’s 40,
she could have 40 years of life ahead of her if the disease doesn’t
come back, whereas, if you’re 60 or 70, you don’t have
40 years of life ahead of you. So, the absolute benefit of five
years of tamoxifen is about as great in the younger woman with ER+
disease as in the older women with ER+ disease. The absolutely benefit
in terms of 10-year outcome. But, because the younger woman’s
got more years ahead of her, it’s actually more important.
And yet, unfortunately, there’s still this tradition that some
medical oncologists haven’t been using hormonal therapy in
younger women. They’ve been using chemotherapy and then not
following it with hormonal therapy, even if the woman had ER+ disease.
And that does seem to be a mistake. I think it’s a long-established
tradition. I think it’s a mistaken one.
Relevant
Articles:
Selective
estrogen receptor modulators: Structure, function, and clinical
use [Review]. Osborne,
C. K. and Fuqua, S. A. W. Journal of Clinical Oncology. 18(17):3172-3186,
2000 Sep.
Similarities
and distinctions in the mode of action of different classes of antioestrogens
[Review]. Wakeling,
A. E. Endocrine-Related Cancer. 7(1):17-28, 2000 Mar. No abstract
Approaches
targeted to estrogen receptors for treatment of tamoxifen-resistant
breast cancer: A brief overview. Terakawa, N. (Reprint available from: Terakawa N Tottori Univ,
Sch Med, Dept Obstet & Gynecol Yonago Tottori 683 Japan)..
Oncology. 59(Suppl 1):3-4, 2000. No abstract
Preliminary
assessment of cognitive function in breast cancer patients treated
with tamoxifen. Paganini-Hill,
A. and Clark, L. J. Breast Cancer Res.earch & Treatment. 64(2):165-176,
2000 Nov.
Symposium
overview: Estrogens and antiestrogens in managing the patient with
breast cancer. Newman,
L. A.; Wood, W. C.; Sellin, R. V.; Morrow, M.; Vogel, C., and Singletary,
S. E. (Reprint available from: Singletary SE Univ Texas, MD Anderson
Canc Ctr, Dept Surg Oncol 1515 Holcombe Blvd,Box 106 Houston, TX
77030 USA).. Annals of Surgical Oncology. 7(8):568-574, 2000 Sep.
In process
The
ovary: cysts, screening, and tamoxifen. Mourits,
M. J. E.; van der Zee, A. G. J.; Willemse, P. H. B., and de Vries,
E. G. E. (Reprint available from: de Vries EGE Univ Groningen Hosp,
Dept Med Oncol POB 30 001 NL-9700 RB Groningen Netherlands). Lancet.
355(9220):2078-2079, 2000 Jun 10.
Concentrations
of tamoxifen and its major metabolites in hormone
responsive and resistant breast tumours. MacCallum, J.; Cummings, J.; Dixon, J. M., and Miller, W. R.
(Reprint available from: MacCallum J Napier Univ, Dept Life Sci
Merchiston Campus,Colinton Rd Edinburgh EH10 5DT Midlothian Scotland)..
British Journal of Cancer. 82(10):1629-1635, 2000 May.
How
is tamoxifen's action subverted? Jordan, V. C. (Reprint available from: Jordan VC Northwestern
Univ, Sch Med, Rober H Lurie Comprehens Canc Ctr 303 E Chicago Ave,Olson
Pavil 8258 Chicago, IL 60611 USA). Journal of the National Cancer
Institute. 92(2):92-94, 2000 Jan 19. No abstract
Serum
lipid levels during and after adjuvant toremifene or tamoxifen therapy
for breast cancer. Joensuu, H.; Holli, K.; Oksanen, H., and Valavaara, R. (Reprint
available from: Joensuu H Univ Helsinki, Cent Hosp, Dept Oncol Haartmaninkatu
4,POB 180 FIN-00029 Helsinki Finland). Breast Cancer Research &
Treatment. 63(3):225-234, 2000 Oct. In process
One
step forward or one step back with tamoxifen? Gelmon, K. (Reprint available from: Gelmon K British Columbia
Canc Agcy Vancouver BC V5Z 4E6 Canada). Lancet. 356(9233):868-869,
2000 Sep 9. No abstract
Endometrial
protection from tamoxifen-stimulated changes by a evonorgestrel-releasing
intrauterine system: a randomised controlled trial. Gardner, F. J. E.; Konje, J. C.; Abrams, K. R.; Brown, L. J.
R.; Khanna, S.; Al-Azzawi, F.; Bell, S. C., and Taylor, D. J.. Lancet.
356(9243):1711-1717, 2000 Nov 18. No abstract
Combined
endocrine therapy for breast cancer - New life for an old idea? Davidson, N. E. (Reprint available from: Davidson NE Johns Hopkins
Oncol Ctr 1650 Orleans St, Rm 409 Baltimore, MD 21231 USA). Journal
of the National Cancer Institute. 92(11):859-860, 2000 Jun 7. No
abstract
Risk
and prognosis of endometrial cancer after tamoxifen for breast cancer. Bergman, L.; Beelen, M. L. R.; Gallee, M. P. W.; Hollema, H.;
Benraadt, J., and van LeeuwenF. E.. Lancet. 356(9233):881-887, 2000
Sep 9. IN PROCESS
