Complete Remission following Endocrine or Combined Cytotoxic and Hormonal Treatment in Advanced Breast Cancer

Abstract

Among 422 patients with advanced breast cancer treated in a randomized trial we observed 60 complete responses (CR). Sixteen were achieved among 206 patients treated with endocrine therapy alone and 37 among 216 patients treated with concomitant chemotherapy and endocrine therapy. The incidence of CR in women treated with the concomitant modality was higher in those with dominant soft tissue disease, intermediate in those with osseous or pulmonary involvement, and low in patients with liver metastases. Bone was shown to be the organ most responsive to therapy among patients treated with hormonotherapy, while patients with soft tissue metastases had an unexpectedly low rate of complete remission with this modality. The probability of achieving a CR was inversely proportional to the tumor burden in the patients treated with concomitant chemotherapy and endocrine therapy. For complete responders on hormone treatment alone and for those on combined endocrine and cytotoxic therapy, both median time to progression (26 and 29 months, respectively) and survival (52 and 53 months, respectively) were similar and statistically significantly longer than in partial or minor responders. This observation leads us to the conclusion that the hormonal component is the determinant for the length of a CR.

A Retrospective Series of Long-Term Survivors of Metastatic Breast Cancer in Complete Remission

“…Other studies confirmed this finding [5, 6], although the majority of patients were chemo-naïve. Consequently, it is difficult to translate the concept of curability of a minority of MBC patients in an era in which nearly all patients have previously received adjuvant cytotoxic therapy.…”

Complete remission after ovariectomy for advanced breast cancer correlated with estrogen receptor status and urinary androgen excretion

“…Despite various modalities in the therapeutic approach to advanced breast cancer, the incidence of CR is generally lower than observed in our study [2]. However, the presence of a CR does improve the prognosis of the disease [2]. The high percentage of CR in our study further supports the conclusions of our previous report [1] on the importance of performing the hormone test for a rational indication for ovariectomy, not only in cases of advanced carcinoma but also as adjuvant therapy.…”

“…Despite various modalities in the therapeutic approach to advanced breast cancer, the incidence of CR is generally lower than observed in our study [2]. However, the presence of a CR does improve the prognosis of the disease [2].…”

Dormant Tumors Awaken by a Short-Term Angiogenic Burst: The Spike Hypothesis

“…16,20,21 Interestingly, most of what is known about medical induction of tumor dormancy regards hormone-related interventions; long-term cytostatic effects on tumors have been achieved by hormone withdrawal in selected groups of cancer patients. 22 The immune system, through either antibody or cell-mediated effectors, can readily contribute to induce and maintain microscopic tumors dormant, especially in lymphoma models. 23,24 Cytotoxic T cells can restrain tumor growth through both cytolytic mechanisms and release of certain cytokines, including IL-2 and IFN-γ; 25,26 moreover, anti-idiotype antibodies have been found to bind B lymphoma cells and signal both cell cycle arrest and apoptosis.…”