- 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
- By increasing the levels of:
- Transforming growth factor-alpha and transforming growth factor-beta:
- But also by modulating the production of:
- 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
- Irrespective of receptor status:
- Tamoxifen prolongs disease-free survival (DFS):
- Tamoxifen acts not only by blocking the ER pathway:
- 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%
- DFS:
- With tamoxifen added to chemotherapy:
- No significant improvement in DFS or overall survival (OS):
- 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
- That found that four cycles of AC are equivalent to six cycles of CMF:
- The NSABP B-23 confirmed the results of NSABP B-15:
- In an attempt to determine whether tamoxifen:
#Arrangoiz #BreastSurgeon #CancerSurgeon #Teacher #SurgicalOncologist
Rodrigo Arrangoiz MS, MD, FACS, FSSO 