A randomized comparison of tamoxifen with surgical oophorectomy in premenopausal patients with advanced breast cancer.

Abstract

We randomized 122 premenopausal women to receive tamoxifen or to undergo a surgical oophorectomy. Of 54 evaluable women treated with tamoxifen, 24% had an objective response, as compared with 21% of 53 women having an oophorectomy. The median duration of response for tamoxifen (20 months) was longer than that for surgical oophorectomy (7 months), but this did not achieve statistical significance (P = .056). Overall median survival was 15 months for 58 patients receiving tamoxifen and 25 months for 53 patients undergoing oophorectomy (P = .18). Toxicity was greater in those undergoing oophorectomy, though both treatments were well tolerated. In those premenopausal women for whom hormonal therapy is indicated, tamoxifen is a suitable alternative to surgical oophorectomy.

Goserelin (Zoladex) in premenopausal advanced breast cancer: duration of response and survival

“…A theoretical limiting factor to treatment with LH-RH agonists, as with radiation castration is their inability to immediately suppress ovarian activity; surgical oophorectomy produces castrate levels of oestradiol within 2 to 7 days (Vermeulen, 1976;Beksac et al, 1983). Despite these theoretical shortcomings we reported a response to goserelin of 31% in a phase I study of 53 premenopausal patients , a value that is comparable to our previous experiences using surgical oophorectomy (Buchanan et al, 1986). When we examined the results of 23 assessable patients who had received a combination of goserelin and the antioestrogen tamoxifen we reported a 22% response, with a further 22% of patients showing static disease (Robertson et al, 1989a).…”

“…In a study of 53 premenopausal patients we reported a response rate to goserelin of 31%; comparable to our previous experience of surgical oophorectomy Buchanan et al, 1986). Recently we have described our experience of combining goserelin with the anti-oestrogen tamoxifen (Robertson et al, 1989a;.…”

Reversible control of oestradiol-stimulated growth of MCF-7 tumours by tamoxifen in the athymic mouse

“…The level of oestradiol we selected was targeted to be within the range normally observed in premenopausal patients during tamoxifen therapy (500-900 pg ml-'). Tamoxifen controlled oestradiol stimulated growth; a result that parallels clinical experience (Breast Cancer Trials Committee, Scottish Cancer Trials Office, 1989;Buchanan et al, 1986;CRC Adjuvant Breast Trial Working Party, 1988;Fisher et al, 1989;Ingle et al, 1986;Manni & Pearson, 1980;Nolvadex Adjuvant Trial Organization, 1988;Sawka et al, 1986).…”

“…Tamoxifen was originally introduced to treat advanced breast cancer in postmenopausal patients (Cole et al, 1971), however the drug has proved to be effective in premenopausal patients as well (Buchanan et al, 1986;Ingle et al, 1986;Manni & Pearson, 1980;Sawka et al, 1986). Recently tamoxifen has been evaluated as an adjuvant therapy in premenopausal women with either node positive (CRC Adjuvant Breast Trial Working Party, 1988;Nolvadex Adjuvant Trial Organization, 1988) or node negative disease (Breast Cancer Trials Committee, Scottish Cancer Trials Office, 1987;CRC Adjuvant Breast Trial Working Party, 1988;Fisher et al, 1989).…”

LHRH analogues and breast cancer

“…The two randomised trials cited (Buchanan et al, 1986;Ingle et al, 1986) to support the notion that tamoxifen is as effective as oophorectomy do not ' . .…”