Breast cancer hormone receptor levels and benefit from adjuvant tamoxifen in a randomized trial with long-term follow-up

Authors

  • Helena Fohlin Regional Cancer Center South-East Sweden and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden https://orcid.org/0000-0003-4336-0949
  • Anna Nordenskjöld Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg Sweden
  • Johan Rosell Regional Cancer Center South-East Sweden and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
  • Mårten Fernö Division of Oncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
  • Tommy Fornander Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
  • Lisa Rydén Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden
  • Lambert Skoog Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
  • Bo Nordenskjöld Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
  • Olle Stål Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden

DOI:

https://doi.org/10.2340/1651-226X.2024.40493

Keywords:

Breast cancer, estrogen receptor, tamoxifen, long term

Abstract

Background: Hormone receptor positivity predicts benefit from endocrine therapy but the knowledge about the long-term survival of patients with different tumor receptor levels is limited. In this study, we describe the 25 years outcome of tamoxifen (TAM) treated patients.

Patients and methods: Between 1983 and 1992, a total of 4,610 postmenopausal patients with early-stage breast cancer were randomized to receive totally 2 or 5 years of TAM therapy. After 2 years, 4,124 were alive and free of breast cancer recurrence. Among these, 2,481 had demonstrated estrogen receptor positive (ER+) disease. From 1988, the Abbot enzyme immunoassay became available and provided quantitative receptor levels for 1,210 patients, for which our analyses were done.

Results: After 5 years of follow-up, when all TAM treatment was finished, until 15 years of follow-up, breast cancer mortality for patients with ER+ disease was significantly reduced in the 5-year group as compared with the 2-year group (hazard ratios [HR] 0.67, 95% confidence intervals [CI] 0.55–0.83, p < 0.001). After 15 years, the difference between the groups remained but did not increase further. A substantial benefit from prolonged TAM therapy was only observed for the subgroup of patients with ER levels below the median (HR = 0.62, 95% CI 0.46–0.84, p = 0.002). Similarly, patients with progesterone receptor negative (PR-) disease did benefit from prolonged TAM treatment. For patients with progesterone receptor positive (PR+) disease, there was no statistically significant benefit from more than 2 years of TAM. 

Interpretation: As compared with 2 years of adjuvant TAM, 5 years significantly prolonged breast cancer-specific survival. The benefit from prolonged TAM therapy was statistically significant for patients with ER levels below median or PR-negative disease. There was no evident benefit from prolonged TAM for patients with high ER levels or with PR+ tumors.

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References

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Published

2024-07-05

How to Cite

Fohlin, H., Nordenskjöld, A., Rosell, J., Fernö, M., Fornander, T., Rydén, L., Skoog, L., Nordenskjöld, B., & Stål, O. (2024). Breast cancer hormone receptor levels and benefit from adjuvant tamoxifen in a randomized trial with long-term follow-up. Acta Oncologica, 63(1), 535–541. https://doi.org/10.2340/1651-226X.2024.40493

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Vol. 63 (2024): Acta Oncologica

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Copyright (c) 2023 Helena Fohlin, Anna Nordenskjöld, Johan Rosell, Mårten Fernö, Tommy Fornander, Lisa Rydén, Lambert Skoog, Bo Nordenskjöld, Olle Stål

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