Tamoxifen (Nolvadex) versus adrenalectomy in metastatic breast cancer.

The relative efficacy of adrenalectomy and tamoxifen (Nolvadex) was evaluated in a randomized study of 51 patients with metastatic breast cancer. In 25 patients undergoing adrenalectomy, there were 13 responders. There were 9 responders of 26 patients receiving tamoxifen. There was no statistically significant difference. In the crossover phase, 15 patients received tamoxifen following adrenalectomy and 3 responded, one of the 6 previous adrenalectomy responders and 2 of the 9 adrenalectomy nonresponders. Nine patients underwent adrenalectomy following tamoxifen, and there were five responders, one of two tamoxifen responders and four of seven tamoxifen nonresponders. Both tamoxifen and adrenalectomy were effective modalities, and appear to retain effectiveness in crossover trials. The frequency of remission was similar in both groups treated by both modalities in different sequences. Response rates to adrenalectomy, considered as both primary and secondary therapy, were significantly higher, since 18 of 34 patients (53%) responded to this therapy, whereas 12 of 41 (29%) responded to tamoxifen as either primary or secondary therapy.