An analysis of possible prognostic features of long term and short term survivors of metastatic breast cancer.

Factors influencing the extremes of survival in disseminated breast cancer were analysed. From a pool of 1066 patients with distant metastatic breast cancer, the 41 patients who had survived 5 yr or more from first distant recurrence were matched with the 41 patients with the shortest survival times. Both groups were compared with the pool and, where relevant, with each other.

Treatment of advanced postmenopausal breast cancer with an aromatase inhibitor, 4-hydroxyandrostenedione: phase II report.

4-Hydroxyandrostenedione (4-OHA), a potent new aromatase inhibitor, was given i.m. (500-1000 mg) to 58 patients with advanced postmenopausal breast cancer.

In vitro and in vivo effects of a monoclonal antibody-toxin conjugate for use in autologous bone marrow transplantation for patients with breast cancer.

We have devised a method utilizing a monoclonal antibody-toxin conjugate (LICR-LON-Fib75/abrin A-chain) for ridding bone marrow of infiltrating breast cancer cells to rescue patients with autologous bone marrow following high dose therapy. Initially we examined the activity of this conjugate in vitro. Five of seven human breast cancer cell lines were killed following exposure at 10(-8) M for 2 h; this concentration only reduced bone marrow colony formation to 83% (range, 50-100%) of control bone marrow.

Immunocytochemical assay for estrogen receptor in patients with breast cancer: relationship to a biochemical assay and to outcome of therapy.

We developed an immunoperoxidase technique using a monoclonal antibody to the estradiol receptor (ER) to identify immunoreactive ER (iER) in breast carcinomas and compared this with the conventional dextran-coated charcoal (DCC) steroid binding assay. We also examined the relationship between the iER and response to therapy in patients with advanced breast cancer. We found iER-positive cells in 60 of 90 carcinomas (66.

Immunocytochemical assay for estrogen receptor: relationship to outcome of therapy in patients with advanced breast cancer.

We have used an immunoperoxidase technique utilizing a monoclonal antibody to the estradiol receptor to identify immunoreactive estradiol receptor in breast carcinomas and have examined the relationship between the immunoreactive estradiol receptor and response to therapy in patients with advanced breast cancer. Fifty-six patients were found to be assessable for response to endocrine therapy. Twenty-two showed an objective response to some form of endocrine manipulation, and all these had positively stained carcinomas.

High-dose oral medroxyprogesterone acetate in heavily pretreated patients with metastatic breast cancer.

Fifty heavily pretreated postmenopausal patients with advanced breast cancer were treated with oral medroxyprogesterone acetate (1 g) daily for 1-18 months. Eight patients (16%) responded to treatment for periods up to 18 months and in an additional eight patients (16%) the disease stabilized for up to 10 months. Thirty-two patients (64%) developed adverse effects and eight (16%), all of whom had extensive pulmonary metastases, died a respiratory-related death thought possibly to have been brought on or accelerated by treatment.

Prognostic significance of micrometastases in bone marrow in patients with primary breast cancer.

Metastatic breast cancer cells were found in the bone marrow of 60 (23%) of 269 patients with primary breast cancer, none of whom had metastatic disease disclosed by any other investigation, including bone scanning and radiological skeletal survey. We estimated the number of cancer cells as less than or more than 20 cancer cells seen. Twenty-six patients had less than 20 cancer cells present, and 34 had 20 or more.

A double blind randomised clinical trial of adjuvant aminoglutethimide versus placebo given to post menopausal patients with histologically confirmed stage II breast cancer.

A multicentre double blind trial is underway to evaluate aminoglutethimide (AG) (Orimeten, Ciba) 1.000 mg/day with hydrocortisone (HC) 20-40 mg/day versus placebo for adjuvant treatment of post menopausal patients with histologically confirmed stage II breast cancer. An interim analysis in February 1985 indicates that of 338 patients randomised 165 received AG + HC and 173 received placebo.

Survey of treatment of primary breast cancer in Great Britain.

A postal survey of current management of breast cancer among surgeons in Great Britain was carried out. The results showed that there is no consensus among surgeons about the treatment of primary breast cancer. Many different types of primary surgery are practised, and patterns of referral for postoperative radiotherapy vary widely.

Trilostane therapy for advanced breast cancer.

Forty-one postmenopausal patients with advanced breast cancer have been treated with trilostane, a 3 beta D-hydrogenase delta 5-isomerase inhibitor, for periods of up to 1 year. One patient responded to trilostane and in six patients the disease was stabilized. The remaining patients failed to respond to therapy.

The treatment of postmenopausal women with advanced breast cancer with buserelin.

Repeated administration of long-acting analogues of gonadotrophin-releasing hormone down-regulates the pituitary gonadotrophins and gonadal hormones. The activity of these compounds in premenopausal women with breast cancer has been previously noted. In an attempt to cause a highly selective medical hypophysectomy 18 consecutive postmenopausal women with symptomatic advanced breast cancer were treated with intranasal buserelin in divided dosages of either 600 or 1000 micrograms daily.

The modulating effects of flurbiprofen on adriamycin plus vincristine or vindesine in the treatment of advanced breast cancer.

To assess the modulating effects of a non-steroidal anti-inflammatory drug on chemotherapeutic agents, 183 patients with advanced breast cancer have been treated in a randomised study with flurbiprofen or placebo and adriamycin plus a vinca alkaloid. To assess the efficacy of the new vinca alkaloid, vindesine, in breast cancer, patients were further randomised to receive vindesine or vincristine. The overall response rate in evaluable patients was 57%, and the median duration of response in the different treatment groups varied from 6 to 10 months.

Treatment of disseminated breast cancer with tamoxifen, aminoglutethimide, hydrocortisone, and danazol, used in combination or sequentially.

222 patients with disseminated breast cancer have been randomised to receive either a combination of hormone therapies using tamoxifen, aminoglutethimide with hydrocortisone, and danazol (TAD), or tamoxifen alone. The response to the combination was significantly better (43%) than that to tamoxifen alone (31%). Patients who relapsed after response or failed to respond to tamoxifen were subsequently treated with aminoglutethimide and then, if possible, with danazol.

Mitomycin C, melphalan and methotrexate combination chemotherapy for palliation of disseminated breast cancer.

Fifty-seven patients with metastatic breast carcinoma have been treated with mitomycin C (10 mg/m2 IV 6-weekly), melphalan (6 mg/m2 PO X 3 days, 3-weekly), and methotrexate (35 mg/m2 IV 3-weekly) to assess the efficacy and toxicity of this regimen. Of 48 evaluable patients 19 (40%) responded for a median period of 5 months and 12 (25%) had stabilisation of disease. Of the 12 patients previously treated with adriamycin only one responded, whereas 18 of the 36 patients without previous chemotherapy responded.

Detection of micrometastases in patients with primary breast cancer.

An immunocytochemical method was used to screen smears obtained at primary surgery from multiple bone-marrow sites in 110 patients with breast cancer; at this time other techniques did not reveal metastases. Tumour cells were detected in the bone-marrow of 31 (28%) patients. The number of cells detected ranged from 1 to greater than 500; none was detected in conventionally stained smears.

The role of aromatase inhibitors in breast cancer.

Aminoglutethimide (AG) has antitumor activity in disseminated breast cancer similar to that of surgical adrenalectomy. AG works by blocking conversion of aromatase enzymes necessary for conversion of androgens to estrogens. Tumor response in patients with disseminated disease has been approximately 30%, with a further 13% of patients achieving stabilization of disease.

Detection of breast carcinoma metastases in bone: relative merits of X-rays and skeletal scintigraphy.

Of 1116 patients receiving primary treatment for breast carcinoma at the Royal Marsden Hospital since 1976, 651 had an abnormal bone scintigram either at primary diagnosis (378) or on subsequent follow-up (273) and 167 developed radiographically detectable bone metastases (21 at the time of primary diagnosis). Comparison of bone scintigrams and X-rays showed that scintigraphy was an inaccurate localiser of existing radiographic detectable metastases. If X-rays alone are used to detect bone metastases a limited examination with five plates will detect metastases with 92% accuracy.

Assessment of response of bone metastases to systemic treatment in patients with breast cancer.

Seventy-one patients with breast cancer and bone metastases, together with other assessable sites of disease, were monitored by radiologic skeletal survey, bone scanning, pain charts, bone marrow aspirate, serum calcium, alkaline phosphatase and urine hydroxyproline/creatinine ratio. On the basis of UICC criteria of response in nonosseous sites, 37 were classed as responders and 34 as nonresponders. Responding patients with osteolytic disease frequently showed sclerosis, but only at 6-8 months, whereas patients with mixed lytic/sclerotic or sclerotic metastases frequently showed no change or further sclerosis.

The role of computed tomography in the detection of bone metastases in breast cancer patients.

Computed tomography (CT) of bone was carried out in 20 patients with breast cancer, all of whom had abnormal radionuclide uptake on skeletal scintigrams but normal conventional radiographs. Twenty-eight sites were examined and 13 showed metastases in 11 patients. Five of these patients had no evidence of extra-skeletal recurrent disease.