Anti-oestrogens in the treatment of breast and gynaecological cancers.
Tamoxifen is an effective therapy for advanced breast cancer and is well tolerated. In elderly patients or in those with inoperable primary disease tamoxifen is as effective as surgery or radiotherapy. In early breast cancer tamoxifen is associated with a prolongation of disease-free and overall survival, at least in women over the age of 50 with nodal involvement. Major trials now suggest that the effectiveness of tamoxifen may, however, be independent of age, menopausal status and of nodal status, but this remains the subject of substantial controversy. These trials also suggest that longer periods of tamoxifen treatment (more than 2 years) are better than shorter treatments and, therefore, adjuvant tamoxifen until recurrence may be the final treatment of choice for such patients. Tamoxifen is also effective in the treatment of endometrial cancer; however, there seems little advantage in combining the drug with progestogens, either concurrently or sequentially. Modest clinical benefit has been seen in patients with ovarian cancer treated with tamoxifen but the majority of patients have been heavily pretreated. Clinical trials of tamoxifen as primary therapy for this disease are warranted. Tamoxifen has probably been the most widely studied endocrine therapy for breast cancer and the subject of some of the longest and best controlled studies. Although there is no doubt that tamoxifen is effective in adjuvant therapy of breast cancer, the precise position and duration of treatment remains to be defined unequivocally. Future use in the treatment of women at high risk of developing breast cancer--so-called prophylactic therapy--depends on improvements in risk factor determination and a continuing evaluation of the possible clinical relevance of findings in animals given long-term treatment with high doses of the drug.
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D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols; D001943:Breast Neoplasms / Q000188:drug therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000188:drug therapy*; D013629:Tamoxifen / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D014594:Uterine Neoplasms / Q000188:drug therapy*
D013629:Tamoxifen