Boca Raton Comprehensive Cancer Center, Boca Raton, Florida 33428, USA.
Clin Ther. 2009;31 Pt 2:2371-8. doi: 10.1016/j.clinthera.2009.11.002.
High-dose estrogens (HDEs) are an efficacious but widely overlooked treatment option for patients with metastatic breast cancer (MBC). This is due in part to the introduction of tamoxifen in the 1970s, which was proven to be equivalent in efficacy and associated with fewer adverse events (AEs).
The aim of this study was to report our experience with the use of HDE in postmenopausal women with advanced breast cancer.
Local institutional review board approval was obtained to conduct a retrospective chart review of patients with MBC treated with HDEs at the Boca Raton Comprehensive Cancer Center, Boca Raton, Florida, from 2001 through March 2009. Demographic information, response rates, and tolerability profiles were collected.
Of the 426 patients with MBC identified, we found 26 patients with MBC who were prescribed HDEs as a treatment in any line of therapy for advanced breast cancer. The median age at the start of HDE therapy was 59 years (range, 42-92 years). Three of the 26 patients (11.5%) were human epidermal growth factor receptor 2-positive determined via fluorescent in situ hybridization analysis. With the exception of 1 patient who had received no prior systemic treatment for metastatic disease, all patients received multiple lines of treatment (both chemotherapy and hormonal treatments) in the advanced setting (median, 7 lines; range, 0-12) prior to the initiation of HDE. Five of 20 patients (25%) with measurable metastatic disease (visceral and/or soft tissue metastases) had objective antitumor responses defined as either a partial response (PR) or a complete response (CR). Four additional patients (20%) had prolonged stable disease (SD) for > or =6 months. Three of 6 patients (50%) with nonmeasurable metastatic disease (bone-only) had prolonged SD for > or =6 months. Clinical benefit rate (defined as CR + PR + SD > or =6 months) for all patients was 46% (12/26), with a median duration of 10 months. Overall median progression-free survival for the 26 subjects was 5 months. Median survival from the start of HDE was 17 months (range, 3-54 months). AEs included fluid retention (8 [31%]), vaginal bleeding (7 [27%]), and nausea (4 [15%]). Two patients discontinued therapy after 1 month. Three of the remaining 24 patients discontinued estrogen therapy due to AEs.
This retrospective chart review details our facility's experience with the use of HDE in patients with advanced breast cancer, most of whom had received multiple prior treatments. Our data suggest that this treatment is another option for heavily-treated patients in whom further endocrine manipulation might still be appropriate.
大剂量雌激素（HDE）是一种有效的治疗方法，但在转移性乳腺癌（MBC）患者中却被广泛忽视。部分原因是 20 世纪 70 年代引入了他莫昔芬，其疗效相当，不良反应（AE）也较少。
本研究旨在报告我们使用 HDE 治疗绝经后晚期乳腺癌患者的经验。
获得当地机构审查委员会的批准，对佛罗里达州博卡拉顿综合癌症中心 2001 年至 2009 年 3 月期间接受 HDE 治疗的 MBC 患者进行回顾性病历审查。收集人口统计学信息、反应率和耐受性概况。
在确定的 426 例 MBC 患者中，我们发现有 26 例 MBC 患者在晚期乳腺癌的任何一线治疗中接受 HDE 治疗。HDE 治疗开始时的中位年龄为 59 岁（范围为 42-92 岁）。其中 3 例（11.5%）通过荧光原位杂交分析确定为人表皮生长因子受体 2 阳性。除了 1 例转移性疾病患者未接受过任何系统治疗外，所有患者在接受 HDE 治疗前均在晚期接受了多种治疗（化疗和激素治疗）（中位数，7 线；范围，0-12）。20 例可测量转移性疾病（内脏和/或软组织转移）患者中有 5 例（25%）有客观抗肿瘤反应，定义为部分缓解（PR）或完全缓解（CR）。另外 4 例（20%）患者有超过 6 个月的疾病稳定（SD）。6 例（50%）无可测量转移性疾病（仅骨转移）的患者中有 3 例有超过 6 个月的 SD。所有患者的临床受益率（定义为 CR+PR+SD>6 个月）为 46%（12/26），中位持续时间为 10 个月。26 名患者的总体中位无进展生存期为 5 个月。从 HDE 开始的中位总生存期为 17 个月（范围为 3-54 个月）。AE 包括液体潴留（8[31%]）、阴道出血（7[27%]）和恶心（4[15%]）。2 名患者在 1 个月后停止治疗。其余 24 名患者中的 3 名因 AE 停止了雌激素治疗。
本回顾性病历审查详细介绍了我们机构在晚期乳腺癌患者中使用 HDE 的经验，其中大多数患者接受了多种先前的治疗。我们的数据表明，对于接受过多治疗的患者，这种治疗是另一种选择，因为进一步的内分泌治疗可能仍然合适。
