title: Exemestane as primary treatment of oestrogen receptor-positive breast cancer in postmenopausal women: a phase II trial.
abstract: To assess the efficacy of exemestane as neoadjuvant treatment, 55 postmenopausal women (mean age: 76 years; range: 66-86) with oestrogen-positive non-metastatic breast tumour and ineligible for conservative surgery were recruited into this phase II trial to receive oral exemestane (25 mg day(-1)) for 6 months. Tumour response was evaluated by clinical examination, mammography and breast ultrasound every 2 months (RECIST criteria). Overall clinical response to treatment was observed in 33/54 patients (61.1%; 95% CI: 48.1-74.0). Radiological responses in 45 evaluable patients were partial response in 23, stable disease in 21 and disease progression in one. Median time to surgery from the commencement of treatment was 7 months; conservative surgery in 24 patients (55.8%) and mastectomy in 19 patients (34.5%); no surgery (patient choice or considered not suitable by attending physician) in 12 patients. Pathologic complete response was observed in breast and axilla in one patient (2.3%) and different forms of persistent disease in 23 (53.5%) patients. Treatment tolerance was good. No patient withdrew from the study because of toxic events. We conclude that exemestane as a primary treatment is feasible and very active in elderly patients with large-sized breast cancer tumour. Conservative surgery is feasible in responding patients. No severe adverse events were detected. The optimal hormonal treatment schedule remains to be determined.
authors.affiliation: Medical Oncology Department, Hospital Universitari Germans Trias i Pujol, Institut Català d'Oncología, Badalona, Spain. abarnadasm@santpau.cat
authors.forename: A
authors.initials: A
authors.lastname: Barnadas
authors.forename: M
authors.initials: M
authors.lastname: Gil
authors.forename: S
authors.initials: S
authors.lastname: González
authors.forename: I
authors.initials: I
authors.lastname: Tusquets
authors.forename: M
authors.initials: M
authors.lastname: Muñoz
authors.forename: A
authors.initials: A
authors.lastname: Arcusa
authors.forename: L
authors.initials: L
authors.lastname: Prieto
authors.forename: M
authors.initials: M
authors.lastname: Margelí-Vila
authors.forename: A
authors.initials: A
authors.lastname: Moreno
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000730:Androstadienes / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000601:surgery; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D011960:Receptors, Estrogen / Q000378:metabolism*; D016019:Survival Analysis
chemical_list: D000730:Androstadienes; D000970:Antineoplastic Agents; D047072:Aromatase Inhibitors; D011960:Receptors, Estrogen; C056516:exemestane