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Hormonal therapies in breast cancer.

1974; National Institutes of Health; Volume: 1; Issue: 2 Linguagem: Inglês

BJ Kennedy,

Estrogen and related hormone effects

Primary endocrine therapy is initially indicated for patients with disseminated breast cancer. Secondary endocrine therapy is utilized after evaluating response to the primary endocrine therapy. When the hormonal therapies are no longer effective cytotoxic chemotherapy is employed. A 2-month period is needed to evaluate tumor response. In premenopausal women bilateral ovariectomy has resulted in objective improvement in 40% of cases. The average duration of such improvement has been 9 months. Castration has had no value in postmenopausal women. Prophylactic castration done at the time of mastectomy is not more effective than therapeutic castration done at the time of recurrence of the cancer. Patients who have demonstrated a definite response following therapeutic castration are upon reactivation of the cancer candidates for hypophysectomy adrenalectomy or adrenocorticosteroid hormone administration. Replacement therapy for symptoms should not be employed in patients responding to castration. However in those not responding to castration hormones can be used without adverse effect. For postmenopausal women primary endocrine treatment is estrogenic hormone. Over 50% of patients will improve. Diethylstilbestrol 5 mg 3 times a day is commonly used. About 90% of patients will show some improvement in 8 weeks. Complete regression may take several months. The duration of response has usually been less than 2 years. Histologically stromal hyperplasia is markedly increased following hormonal therapy. There may be adverse side effects from hormone therapy. Hypercalcemia can be controlled with mithramycin therapy. Massive doses of estrogenic hormones in premenopausal women have produced tumor regression in a few patients without aggravation of the disease in others. Androgenic hormones have been found to be effective in postmenopausal women with osseous metastases. Massive doses of progestins have produced regression in 20-30% of cases. Oral contraceptives may stimulate the rate of growth of an existing breast tumor but no data suggest that breast cancer is induced by the use of oral contraceptives. Carcinoma of the breast arising during pregnancy or lactation has been associated with an ominous prognosis. In male breast cancer antitumor measures are directed against removal of androgens. Orchidectomy is employed. Adrenalectomy or hypophysectomy have been used as secondary therapy.