ADJUVANT USE OF ANTIPROLACTIN, ANTIESTROGEN, AND CYTOTOXIC CHEMOTHERAPY FOR BREAST-CANCER

Between September 1, 1985 and September 1, 1989, 110 premenopausal pat ients with estrogen-receptor-positive, stage-II breast cancer were ran domized to receive, as adjuvant treatment following radiotherapy, eith er cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) + tamoxife n (T) + bromocriptine (B) bases or CMF + T only. Preoperative serum pr olactin (PRL) levels or PRL-receptor status of the tumor were not avai lable, but before the commencement of adjuvant therapy serum PRL level s were measured in all patients and found to be high in 28. The local (LR) and distant (DM) metastasis-recurrence rates were lower in patien ts given bromocriptine (CMF + T + B) (LR, 5.7%; DM, 10.9%) than in tho se not given bromocriptine (CMF + T) (LR, 10.9%; DM, 27.2%); these fin dings, however, were not significant (P > 0.05). In the 28 hyperprolac tinemic patients the metastasis-recurrence rate (17/28) was higher (P = 0.0001) and disease-free survival was shorter (P = 0.001) than in th e 80 normoprolactinemic patients. It was also demonstrated that the di sease-free survival was longer (P = 0.009) and the metastasis-recurren ce rate was lower (6/12) in hyperprolactinemic patients who received b romocriptine (CMF + T + B) than in hyperprolactinemic patients who did not (CMF + T) (11/16), while there was no difference in metastasis-re currence rates and disease-free survival between the two treatment gro ups among normoprolactinemic patients. These results encourage further investigation of the action of bromocriptine adjuvant base. Baseline serum PRL measurement and tumor PRL-receptor determination could be va luable tools to identify the appropriate cases for antiprolactinemic t reatment.