Giordano et al. (2002)

Giordano et al. (2002)
Design: Retrospective case series (therapy), evidence level: 3
Country: USA
Inclusion criteria:
Men with metastatic breast cancer.
Exclusion criteria:
None stated
Number of patients = 5, age range: 48 to 88 years. Mean age: 71 years
Anastrozole (ANA) at 1 mg per day.
Tumour response (complete response CR, partial response PR, stable disease SD, disease progression PD).
Follow up:
No details.
Case 1:
Diagnosis: 57 years – breast mass plus one lymph node – radical mastectomy and adjuvant chemotherapy with CMF, chest wall RT and tamoxifen with RD of 5 years.
Relapse: lung metastases. Treatment with aminoglutethimide with RD of 12 months.
Relapse: treated with higher dose of aminoglutethimide and steroids with SD of 3 months.
Relapse: 63 years - lung disease progressed. Given ANA with SD of 9 months then PD in lungs.

Case 2:
Diagnosis: 75 years – breast mass plus two lymph nodes – radical mastectomy only. RD 9 years.
Relapse: axillary mass. Treatment with tamoxifen (TAM) for a CR of 1 year. Lost to follow-up for 1 year.
Relapse: treatment with tamoxifen again with a further 1 year CR.
Relapse: chest wall disease and axillary lymph nodes. Given TAM with PR of 14 months
Relapse: 88 years – chest wall metastases and axilla. Given ANA discontinued with PD after 2 months. Had multiple co-morbidities including hypertension, CHF and atrial fibrillation.

Case 3:
Diagnosis: 67 years – breast mass plus four lymph nodes – radical mastectomy and adjuvant chemotherapy with CMF, vincristine & prednisone (6 wks) and CMF (6 months) SD of 3 years.
Relapse: lung metastases. Treated with TAM with CR of 63 months
Relapse: 76 years – lung metastases. ANA therapy given but progressed throughout so discontinued after 3 months.

Case 4:
Diagnosis: 35 years – breast mass plus six lymph nodes – radical mastectomy and adjuvant CMF for 6 months, chest wall and axillary RT with RD of 7 years.
Relapse: lung metastases. Treatment with surgery and TAM. PD after 2 years.
Relapse: lung metastases. Treatment with surgery and TAM. PD after 4 years.
Relapse: 48 years – lung metastases, new disease in axilla. Treated with ANA with SD for 8 months. Discontinued after development of supraclavicular disease.

Case 5:
Diagnosis: 79 years – breast mass with no involved nodes – radical mastectomy and TAM (discontinued after 1 month due to AEs). PD after 3 years.
Relapse: lung and bone metastases. ANA therapy started but discontinued after 4 months with PD in the lungs.
General comments:
This paper reports on five men with metastatic breast cancer who received anastrozole treatment at a single US centre between 1990 and 1999. All the men were ER +ve and all but one (in whom PR status was not measured) were also PR +ve.

None of the five men treated with ANA experienced an objective response but 3/5 had temporary stabilisation of metastatic disease. Two men showed significant clinical benefit, defined as stable disease for more than 24 weeks.

From: Chapter 4, Systemic disease-modifying therapy

Cover of Advanced Breast Cancer
Advanced Breast Cancer: Diagnosis and Treatment.
NICE Clinical Guidelines, No. 81.
National Collaborating Centre for Cancer (UK).
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