Tamoxifen Therapy in Postmenopausal Advanced Breast Cancer: Efficacy at the Primary Tumor Site in 46 Evaluable Patients

Inflammatory Breast Cancer Presenting with Acute Central Venous Thrombosis: A Case Report

Inflammatory breast cancer is a relatively rare disease associated with varied presentations, which frequently obscure the underlying diagnosis. We discuss a 54-year-old woman who presented to our emergency department with a chief complaint of right arm swelling and was admitted to the surgical service with an initial diagnosis of spontaneous brachial, axillary, and subclavian venous thrombosis. Further workup revealed an extensive inflammatory breast cancer. To our knowledge there have been no literature reports of inflammatory breast carcinoma in which the sole presenting symptom complex was due to central venous thrombosis.

Locally advanced primary breast cancer: medium-term results of a randomised trial of multimodal therapy versus initial hormone therapy

We report the medium-term (median follow-up=52 months) results of a prospective randomised trial of multimodal therapy (neoadjuvant chemotherapy, Patey mastectomy, postoperative radiotherapy and adjuvant hormone therapy) (n=56) versus initial hormone therapy (n=52) for locally advanced primary breast cancer. Compared with multimodal therapy, initial hormone therapy was associated with reduced number of therapies for disease control (mean=3.6 versus 4.9) and mastectomy rate (31%). Multimodal therapy conferred better initial locoregional control and a longer disease-free interval. Nevertheless, there was no statistically significant differences in the rates of survival, metastasis and uncontrolled locoregional disease, as well as in the time to metastasis between the two therapy groups. Regardless of the therapy groups, oestrogen receptor positivity conferred a lower metastasis rate, better survival and locoregional control. Thus, initial hormone therapy may be a reasonable option for managing locally advanced primary breast cancer, especially for oestrogen receptor-positive tumours.

Locally advanced breast cancer: early results of a randomised trial of multimodal therapy versus initial hormone therapy

The aim of this study was to investigate initial treatment of locally advanced breast cancer. Patients were randomised to "multimodal" therapy (pre-operative chemotherapy, Patey mastectomy, flap irradiation and adjuvant hormone therapy) (n = 55), or initial "hormone" therapy (n = 53) with further therapy upon tumour progression. The objective response to chemotherapy was 57% (31/54) after four cycles. Of patients on hormone therapy, 36% (19/53) had an objective response and 32% (17/53) disease stasis at a 6 month assessment. At a median 30 months follow-up, there was no notable difference in development of metastases or survival: only 6 patients have uncontrolled loco-regional relapse (4 "hormonal", 2 "multimodal"). The number of treatments per patient required for this loco-regional control was lower in the "hormone" group (mean 2.13 versus 4.20 in the "multimodal" group). This small study has shown that the use of consecutive therapies, with the aim of tumour control, does not appear to compromise outcome in comparison with initial "multi-modal" therapy. Adopting such a policy may allow some patients to avoid unnecessary treatments.

Inflammatory breast cancer: the evolution of multimodality treatment strategies

Inflammatory breast cancer is an aggressive subtype of invasive breast cancer. Early attempts to control the disease with local treatment modalities alone had a minimal impact on survival. More recently, multimodality treatment approaches that integrate systemic chemotherapy, surgery, and radiotherapy have resulted in improved local disease control and prolonged survival. Better systemic therapies need to be developed since metastatic disease develops in the majority of patients.

Therapy for inflammatory breast cancer: impact of doxorubicin-based therapy

BACKGROUND

Inflammatory breast cancer (IBC) carries an ominous prognosis. Before 1988, women with IBC at our institution were treated with neoadjuvant cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) with or without vincristine and prednisone (CMF/VP). After 1988, women with IBC were treated with cyclophosphamide, doxorubicin, and 5-fluorouracil (FAC). This study compares these two regimens with regard to response and survival.

METHODS

The records of all women presenting between January 1973 and December 1991 with a stage IIIB (T4d, any N, MO) breast cancer with proven dermal lymphatic invasion by tumor cells were reviewed retrospectively.

RESULTS

The study comprised 38 women; 28 received CMF (22 CMF, 6 CMF/VP), and 10 received FAC. The overall response rate to induction chemotherapy in the CMF/VP group was 57% (40% PR, 17% CR), and 100% (60% PR, 40% CR) in the FAC group. The median overall survival for women receiving CMF/VP was 18 months compared with 30 months for women receiving FAC (p = 0.02). The median disease-free survivals for the CMF/VP and FAC groups were 6 and 24 months, respectively (p < 0.001). When comparing responders and nonresponders with CMF/VP induction therapy, the responders had a significantly longer overall median survival (24 versus 10 months) (p < 0.001) and disease-free median survival (8 versus 2 months) (p < 0.001). All of the five patients remaining alive received FAC with 80% (four of five) having a complete response. These four patients subsequently underwent mastectomy and radiation.

CONCLUSION

This study suggests that a doxorubicin-containing chemotherapy regimen improves overall and disease-free median survivals when compared with the previously used CMF combination in the treatment of IBC. A favorable response to induction chemotherapy also appeared to be associated with an improved survival.

Management of locally advanced breast cancer

The management of locally advanced breast cancer with single modality therapy has been associated with a high rate of systemic failure. A multimodality treatment strategy that includes induction cytotoxic chemotherapy, surgery, radiation therapy, and, possibly, hormonal ablation therapy is the current preferred management approach. As our knowledge and understanding of the mechanisms involved in mitogenic signal transduction improve, it is likely that less toxic, more efficacious agents will emerge.

In vitro effects of tamoxifen on UM-SCC head and neck cancer cell lines: correlation with the estrogen and progesterone receptor content

Eleven squamous-cell carcinoma (SCC) cell lines derived from patients with head and neck cancer were tested together with the MCF-7 breast carcinoma cell line for in vitro growth inhibition by tamoxifen. MCF-7 is known to contain cytosolic receptors for estrogen (ER), progesterone (PgR), androgen (AR) and glucocorticoid. We have previously reported the ER, PgR and AR contents of these 11 head-and-neck SCC cancer lines. Starting from day 3 or 4 after passage, cultures were fed daily with medium containing 5% dextran-charcoal-treated fetal bovine serum (D5) and 0, 1, 2.5, 5, 7.5 or 10 microM tamoxifen. Eight of the 11 SCC lines and MCF-7 showed more than 60% growth inhibition when fed with 5 microM tamoxifen. Of these 8 SCC cell lines, 3 contained both ER and PgR, 4 contained only PgR, and one contained neither receptor. The 3 cell lines that were not inhibited by tamoxifen failed to express either ER or PgR. The action of tamoxifen on the cell lines was further investigated by examining the reversibility and the rate of recovery from tamoxifen-induced growth inhibition in the presence or absence of estrogen. MCF-7 and two ER- and PgR-positive SCC cell lines, UM-SCC-12 and UM-SCC-9, recovered more rapidly when the tamoxifen was replaced with medium containing 17-beta estradiol (E2) than when it was replaced with D5 medium alone. However, of the other tamoxifen-inhibited cell lines studied, each recovered equally well whether the tamoxifen was replaced with D5 medium or with D5 medium containing E2. Furthermore, some cell lines spontaneously resumed growth within 4 to 5 days in the presence of tamoxifen if no new tamoxifen was added to the culture dish. This ability is specific for some cell lines, and further study is required to determine its significance.