Postgraduate Medical Institute of the University of Hull, Hull, UK; Breast Care Unit, Hull and East Yorkshire NHS Trust, Hull, UK.
Postgraduate Medical Institute of the University of Hull, Hull, UK; Breast Care Unit, Hull and East Yorkshire NHS Trust, Hull, UK; Hull York Medical School, Hull, UK.
Int J Surg. 2014;12(8):821-6. doi: 10.1016/j.ijsu.2014.06.009. Epub 2014 Jul 8.
Primary tamoxifen therapy has been widely used to treat elderly women with ER-positive breast cancer in the past. Aromatase inhibitors may be more beneficial than tamoxifen when used as primary endocrine therapy in elderly patients. We aimed to retrospectively evaluate a series of elderly women with ER-positive breast cancer treated with primary letrozole therapy as sole therapy with a minimum of 5 years follow up. To identify possible predictive biomarkers a pilot immunohistochemical analysis was performed to assess the expression of PR, HER2, EGFR, BCL2 and p53. A total of 45 women, aged more than 70 years with a diagnosis of ER-positive breast cancer that was treated with primary letrozole therapy were identified. A case note review was undertaken to obtain clinical information. Formalin fixed paraffin embedded tumour tissue from diagnostic core biopsies was available for all patients. Immunohistochemical analysis was performed to establish the protein expression status of p53, PR, HER2, EGFR and BCL2. The mean age of the 45 patients was 87 years (range 70-101). Clinical benefit was seen in 60% of the patients. Median progression free survival was 53 months (95% CI - 34-72) and the median time to progression was 43 months (95% CI - 22-64). BCL2 was expressed in 45/45 (100%); PR in 38/45 (84%); EGFR in 13/45 (28%); HER2 in 9/45 (20%) and p53 in 5/45 (11%) of tissue samples. Positive expression of p53 was associated with poor progression free survival (p = 0.03) in this pilot study. This study demonstrates that letrozole as sole treatment appears to be a suitable treatment option for elderly patients with ER-positive breast cancer who are not fit for, or decline, surgery. The analysis of p53 in a larger study is warranted in order to assess its role as a biomarker in this patient group.
过去，原发性他莫昔芬治疗已被广泛用于治疗 ER 阳性乳腺癌的老年女性。与他莫昔芬相比，芳香化酶抑制剂在老年患者中作为主要内分泌治疗可能更有益。我们旨在回顾性评估一组接受原发性来曲唑治疗的 ER 阳性乳腺癌老年女性患者，这些患者接受了至少 5 年的随访。为了确定可能的预测生物标志物，我们进行了一项初步的免疫组织化学分析，以评估 PR、HER2、EGFR、BCL2 和 p53 的表达。共确定了 45 名年龄超过 70 岁的 ER 阳性乳腺癌患者，这些患者接受了原发性来曲唑治疗。进行了病历回顾以获取临床信息。所有患者均有诊断性核心活检的福尔马林固定石蜡包埋肿瘤组织。进行免疫组织化学分析以确定 p53、PR、HER2、EGFR 和 BCL2 的蛋白表达状态。45 例患者的平均年龄为 87 岁（范围 70-101 岁）。60%的患者观察到临床获益。中位无进展生存期为 53 个月（95%CI - 34-72），中位进展时间为 43 个月（95%CI - 22-64）。BCL2 在 45/45（100%）的组织样本中表达；PR 在 38/45（84%）中表达；EGFR 在 13/45（28%）中表达；HER2 在 9/45（20%）中表达；p53 在 5/45（11%）中表达。在这项初步研究中，p53 的阳性表达与无进展生存期较差相关（p = 0.03）。本研究表明，来曲唑作为单一治疗似乎是不适合或拒绝手术的 ER 阳性乳腺癌老年患者的合适治疗选择。为了评估其在该患者群体中的作为生物标志物的作用，有必要在更大的研究中分析 p53。
