Hormone therapy; enabling surgery in post-menopausal breast cancer patients

The authors aimed to determine the long-term effects of hormone therapy to treat post-menopausal women with advanced breast cancer.

Hormone therapy is a form of breast cancer treatment. It targets cancer cells that may be affected by hormones. It is often administered prior to surgery in patients who are unfit to receive chemotherapy, such as older patients or patients with other diseases as well as cancer. The aim of hormone therapy here is to shrink the tumor in order to make surgery possible.

Both before and after surgery, newer hormone therapies such as aromatase inhibitors (Femara, Arimidex, Aromasin) have been suggested to be more effective than tamoxifen (Nolvadex). However, the benefit of hormone therapy with aromatase inhibitors before surgery has not been well studied in post-menopausal patients. 

The aim of this study was to determine the long-term prognosis (treatment outlook) of post-menopausal women with breast cancer who received hormone therapy prior to surgery. 

A total of 144 patients were evaluated, all of whom were hormone receptor positive (HR+; presence of either estrogen receptor or progesterone receptor proteins on cancer cells). Before surgery, 39% of the women were allocated to a course of letrozole (Famara), 57% to exemestane (Aromasin) and 3.5% to anastrozole (Arimidex).

After hormone therapy, 9.6% of patients had complete disappearance of signs and symptoms of cancer, 77% of patients had partial disappearance and 11.8% had no change in their signs and symptoms. 1.5% of patients progressed despite hormone treatment. Almost all patients who achieved complete or partial responses received breast-conserving surgery. Those who received breast-conserving surgery (as opposed to full removal of the breast, mastectomy) were more likely to have a tumor size less than 3 cm at diagnosis and to be negative for HER2 (absence of the HER2 protein on cancer cells). 

After surgery, all patients continued to receive aromatase inhibitors. Some patients also received radiation therapy. 

After an average follow-up of 49 months, 3% of patients had cancer return close to the original site, 12.5% of patients had cancer progress and spread to distant organs and 17% of patients had died. After 5 years, 89% of those who received breast-conserving therapy had survived without cancer compared to 58% of those who had received mastectomy. 

In both simple and advanced analysis, those who were able to undergo breast-conserving therapy after hormone therapy instead of mastectomy were more likely to survive overall, and to survive without disease. 

The authors concluded where hormone therapy for postmenopausal women with advanced breast cancer enables them to receive breast-conserving surgery, long-term outcomes are improved. 

A single surgery team that was responsible for assessing patient eligibility for surgery. Those who received mastectomy were more likely to have had more advanced cancer at diagnosis, which may affect the difference in survival.