Tamoxifen Use in Estrogen Receptor Negative Tumors?

  • Several preclinical studies have demonstrated that:
    • Tamoxifen acts not only by blocking the ER pathway:
      • But also by modulating the production of:
        • Transforming growth factor-alpha and transforming growth factor-beta:
          • By increasing the levels of:
            • Sex hormone-binding globulin in serum
            • Natural killer cell counts
          • By decreasing the levels of:
            • Insulin-like growth factor
    • Additional clinical information suggested that:
      • Tamoxifen prolongs disease-free survival (DFS):
        • Irrespective of receptor status:
          • Although with less magnitude of benefit in ER-negative tumors
  • Due to these data, NSABP protocol B-23 was developed:
    • In an attempt to determine whether tamoxifen:
      • Has a role in patients with ER-negative tumors
    • Patients with ER-negative tumors were:
      • Randomized to four cycles of adjuvant doxorubicin and cyclophosphamide (AC) or six cycles of adjuvant cyclophosphamide, methotrexate, and fluorouracil (CMF) with or without tamoxifen
    • The results of NSABP B-23 demonstrated:
      • No significant improvement in DFS or overall survival (OS):
        • With tamoxifen added to chemotherapy:
          • DFS:
            • CMF, 83%
            • CMF plus tamoxifen, 83%
            • AC, 83%
            • AC plus tamoxifen, 82%
          • OS:
            • CMF, 89%
            • CMF plus tamoxifen, 89%
            • AC, 90%
            • AC plus tamoxifen, 91%
    • Additionally:
      • The NSABP B-23 confirmed the results of NSABP B-15:
        • That found that four cycles of AC are equivalent to six cycles of CMF:
          • In terms of DFS and OS

#Arrangoiz #BreastSurgeon #CancerSurgeon #Teacher #SurgicalOncologist

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