title: Subcutaneous testosterone-letrozole therapy before and concurrent with neoadjuvant breast chemotherapy: clinical response and therapeutic implications.
abstract: OBJECTIVE
  Hormone receptor-positive breast cancers respond favorably to subcutaneous testosterone combined with an aromatase inhibitor. However, the effect of testosterone combined with an aromatase inhibitor on tumor response to chemotherapy was unknown. This study investigated the effect of testosterone-letrozole implants on breast cancer tumor response before and during neoadjuvant chemotherapy.
  
  
  METHODS
  A 51-year-old woman on testosterone replacement therapy was diagnosed with hormone receptor-positive invasive breast cancer. Six weeks before starting neoadjuvant chemotherapy, the patient was treated with subcutaneous testosterone-letrozole implants and instructed to follow a low-glycemic diet. Clinical status was followed. Tumor response to "testosterone-letrozole" and subsequently, "testosterone-letrozole with chemotherapy" was monitored using serial ultrasounds and calculating tumor volume. Response to therapy was determined by change in tumor volume. Cost of therapy was evaluated.
  
  
  RESULTS
  There was a 43% reduction in tumor volume 41 days after the insertion of testosterone-letrozole implants, before starting chemotherapy. After the initiation of concurrent chemotherapy, the tumor responded at an increased rate, resulting in a complete pathologic response. Chemotherapy was tolerated. Blood counts and weight remained stable. There were no neurologic or cardiac complications from the chemotherapy. Cost of therapy is reported.
  
  
  CONCLUSIONS
  Subcutaneous testosterone-letrozole was an effective treatment for this patient's breast cancer and did not interfere with chemotherapy. This novel combination implant has the potential to prevent side effects from chemotherapy, improve quality of life, and warrants further investigation.
authors.affiliation: 1Millennium Wellness Center, Dayton, OH 2Wright State University Boonshoft School of Medicine, Department of Surgery, Dayton, OH 3York Data Analysis, Seattle, WA 41st Department of Ob-Gyn, Athens University Medical School, Athens, Greece 5National Institutes of Health, NICHD, Bethesda, MD.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Glaser
authors.forename: Anne E
authors.initials: AE
authors.lastname: York
authors.forename: Constantine
authors.initials: C
authors.lastname: Dimitrakakis
mesh_terms: D000728:Androgens / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D018427:Breast Implants; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D000077289:Letrozole; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D009570:Nitriles / Q000008:administration & dosage*; D013739:Testosterone / Q000008:administration & dosage*; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage*; D047368:Tumor Burden / Q000187:drug effects
chemical_list: D000728:Androgens; D009570:Nitriles; D014230:Triazoles; D013739:Testosterone; D000077289:Letrozole