TAMOXIFEN AS PRIMARY-TREATMENT OF BREAST-CANCER IN ELDERLY PATIENTS

The authors report on a series of 120 elderly (age over 69) women with primary breast cancer treated with tamoxifen alone. Treatment schedul e was 160 mg on day 1 followed by a daily maintenance dose of 20 mg. C ompliance to treatment was optimal and side effects were minimal. The best results achieved after at least six months of treatments were com plete response in 12, a partial response in 46 and minor response in 1 0 patients, whereas stable disease or progression was observed in 43 o r 9 patients, respectively. Response duration was limited and progress ion was increasingly observed over time. After 6, 12, 24, 36, 48 and 6 0 months the proportion of subjects still showing response to treatmen t was 43%, 57%, 56%, 46%, 32% and 31%, whereas progression rate was 7% , 12%, 25%, 39%, 55% and 60%, respectively, the difference being accou nted for by patients with stable disease. As determined in a subset of 27 subjects, treatment response was strongly associated with immunocy tochemically assessed tumor estrogen receptor content, progressions be ing 100%, 43% or 6% in subjects with 0%, 30-60% or >60% immunostained cells, respectively. These results do not support primary hormone ther apy as a current alternative to surgery, which should be the standard treatment in otherwise healthy elderly patients with operable breast c ancer. When surgery is specifically contraindicated, hormone treatment should be proposed as an alternative only in subjects with high tumor estrogen receptor content.