Hormone therapy in advanced breast carcinoma: present and future trends

Anastrozole: a new addition to the armamentarium against advanced breast cancer

Estrogen manipulation represents an effective treatment for advanced breast cancer in postmenopausal women with estrogen-receptor positive disease. The antiestrogen agent, tamoxifen, is the first choice for advanced breast cancer in postmenopausal women due to its efficacy and lack of significant side effects. As with all cancer treatments, however, cancer may recur after initial treatment with tamoxifen, and the limitations of currently available alternative hormonal therapies in terms of tolerability and convenience of administration underscore the need for new agents. Anastrozole is a new, highly selective, nonsteroidal aromatase inhibitor capable of maximal estrogen depletion with fewer side effects than other hormonal therapies. Anastrozole is administered in a convenient, once-daily oral dosing regimen and does not require steroid replacement therapy. In two multicenter clinical trials, anastrozole was as effective as megestrol acetate for the treatment of advanced breast cancer in postmenopausal women who progressed after tamoxifen therapy, based on objective response rates and time to objective progression of disease. In addition, the drug did not produce the weight gain observed with megestrol acetate therapy. Anastrozole is an effective endocrine agent in the treatment of advanced breast cancer in postmenopausal women.

[Synthetic progestational hormones in the treatment of neoplastic cachexia]

Cachexia frequently occurs in cancer patients. Indeed, this syndrome affects about 50% of hospitalized patients. This clinical entity may be described by different characteristics: appetite and weight loss, several metabolic abnormalities, possible influence of cytokines, poor prognosis. During the last decade, several papers have shown the beneficial activity of medroxyprogesterone acetate (MPA) and megestrol acetate (MA) in cancer cachexia. Seven randomized trials emphasized their activity on patients weight and appetite. Megestrol acetate doses in those trials are different: from 160 mg/24 h to 1600 mg/24 h; this drug is similar to MPA in terms of clinical and pharmacological properties. Iatrogenic toxicity due to MA and MPA is mild, but numerous questions still subsist: optimal date of introduction during the course of the disease, posology, treatment duration and its impact on quality of life of cancer patients.