Interview
with Neil Love, MD Breast Cancer Update for Medical Oncologists,
Program 6 2000
Play
Audio Below:
Dr.
Love: I’ve heard people say, at least in terms of evaluating
adjuvant endocrine therapy, quote, "If there’s any estrogen
or progesterone receptor detected in the assay, that should be considered,
not necessarily strongly positive, but endocrine therapy should
be considered." Do you think that that’s sort of a simplistic
approach that you would support?
Dr.
Osborne: Yes. I think that’s certainly been the case with ligand-binding
assays. I mean some people went to a cutoff of 10. I personally
think that was too high. We always used, in our laboratory, greater
than three. In other words, you can detect it. There are some patients
with those low, but positive values that will benefit. So, I think
a lower cutoff is a better cutoff. And I think the issue is now,
with immunohistochemistry, depending on what antibody you use, what
methodology you use, where is that cutoff. And we better start paying
attention to that or there are going to be patients misclassified.
I think the people we need to educate are the pathologists. Pathologists,
to a large extent, don’t realize the importance of that test.
They certainly put it lower on their priority list compared to the
morphologic description of the tumor, which is pretty much uninteresting,
for the most part. That doesn’t tell us much at all. But the
estrogen receptor test tells us a lot, because we base our treatment
on it. These treatments have major effects on outcome. So, maybe,
educating pathologists would be a start, since they’re the
ones that do the immunohistochemical assay. I think many people
think that the estrogen receptor issue in terms of methodology,
that issue was resolved years ago. But we forget that we’ve
switched over to another assay, and that assay hasn’t been
as well standardized or validated.
Youth
and hormone receptors in breast cancer: good or bad news first? Stockler, M. and Beith, J. (Reprint available from: Stockler
M Univ Sydney, Natl Hlth & Med Res Council, Clin Trials Ctr,
Dept Med Sydney NSW 2006 Australia). Lancet. 355(9218): 1839-1840,
2000 May 27. No abstract
