Historical
perspective on adjuvant endocrine therapy
Interview
with Neil Love, MD from Breast Cancer Update for Medical Oncologists,
Program 2 2000
Play
Audio Below:
From
1948, when we did the first randomized trials in breast cancer and
– actually, they were among the first randomized trials in
medicine ever – and ovarian ablation was one of the two subjects
covered, and by 1975-1978, in that period of time, I was writing
that there was no rule for ovarian ablation and I thought that for
two reasons. One is that the individual trials had not reached levels
of statistical significance. And, secondly, our underlining idea
of what we were doing with adjuvant therapy was that we had to eradicate
all the tumor cells in order to prolong survival. And we know that
we can’t do that with various forms of hormone therapy. We
know that no patient has a tumor that’s all ER-positive and,
therefore, I just jumped to the conclusion we couldn’t prolong
survival. So I was really quite surprised when the first report
came out, which was really from the NATO trial in England, showing
that with adjuvant tamoxifen you could get a prolongation survival,
and they only used two years of tamoxifen in that study. And to
be quite blunt, I didn’t really believe it – and then,
of course, the overview follows shortly thereafter I began to take
it very seriously.
Relevant
Articles:
The
relationship between histological grade, oestrogen receptor status,
events and survival at 8 years in the NATO ('Nolvadex') trial
Singh L. Wilson AJ. Baum M. Whimster WF. Birch IH. Jackson IM. Lowrey
C. Palmer MK. British Journal of Cancer. 57(6):612-4, 1988
Effects
of adjuvant tamoxifen and of cytotoxic therapy on mortality in early
breast cancer: an overview of 61 randomised trials among 28,896
women. Early Breast Cancer Trialists' Collaborative Group.
N Engl J Med 1988; 319: 1681-92.
Adjuvant
endocrine therapy for operable breast cancer. [Review]
Stewart HJ. Bulletin du Cancer. 78(4):379-84, 1991.
