Therapeutic potential of pure antioestrogens in the treatment of breast cancer.

Novel 7 alpha-analogues of 17 beta-oestradiol like ICI 164,384, differ from all antioestrogens described previously in being entirely free of partial agonist activity. In adult rats, ICI 164,384 blocks completely the stimulatory effects of endogenous or exogenous oestrogens and produces a castration-like involution of the uterus without affecting the hypothalamic-pituitary-ovarian axis. If analogous effects were achieved in patients, peripherally-selective complete oestrogen withdrawal would occur, which presents a novel pharmacological option not achieved by any current treatment. Studies with human breast cancer cells showed that ICI 164,384 reduced to a greater extent than did tamoxifen, the mitotic fraction. This difference may reflect a synergistic stimulatory interaction between serum growth factors like insulin, and the partial agonist effect of tamoxifen which is not seen with ICI 164,384. In long-term culture in the presence of ICI 164,384 no resistant cell lines developed, as has been observed previously in studies with tamoxifen. Pure antioestrogens might thus have a further therapeutic advantage over partial agonists like tamoxifen in reducing the probability of treatment failure due to the regrowth of tumours from resistant cells.