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Advantages of multiple clinical tests for determining the optimum treatment strategy for ER-positive breast cancer

Nature Clinical Practice Oncology volume 5, pages 376–377 (2008)Cite this article

Interest in the clinical use of gene-expression profiles has increased tremendously in the past few years, and the prognostic and predictive value of genetic markers is an interesting matter of debate. In patients with breast cancer, the estrogen receptor (ER) protein is a strong predictive marker of response to endocrine therapy, because tumors that do not express ER do not respond to such therapy. ER expression, however, is not an infallible predictor of endocrine responsiveness; the recurrence rate for ER-positive (ER+) breast cancer in patients in whom the primary tumor was thought to be completely resected and who received adjuvant treatment with tamoxifen is approximately 30%.1 These patients are defined as nonresponders, and this population would be larger if it was possible to identify and include patients who were considered to be cured by surgery alone (patients statistically grouped as responders), but actually had tumors that were nonresponsive to treatment. The potential for over-treatment of patients with breast cancer who are 'cured' by surgery and for 'inappropriate' treatment of patients with nonresponsive tumors emphasizes the need to develop prognostic and predictive markers that can better identify which patients require treatment and which patients are likely to respond to which existing therapy options. Such developments would ensure that each patient received optimum treatment on the basis of their individual tumor characteristics.

At present the most common treatment option for ER+ breast cancer is tamoxifen, but newer and more-expensive agents, such as the aromatase inhibitors (AIs), are increasingly being used as adjuvant treatments, and these agents have been shown to improve clinical outcome for postmenopausal women, and not just in those with advanced disease. Tamoxifen is a partial antagonist of the ER, which functions directly in breast tissue, while AIs abrogate the production of the ER ligand, inhibiting its function indirectly. As resistance to tamoxifen is not necessarily associated with resistance to AIs, it is clear that mechanisms and pathways other than those related to receptor or ligand antagonism are involved in the growth of ER+ tumors.2 Mapping of these pathways is currently the focus of intense research.

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Author notes

  1. MB Lyng is a PhD student in the Medical Biotechnology Center at the University of Southern Denmark and the Department of Pathology, Odense University Hospital, Odense, Denmark.

Authors and Affiliations

  1. HJ Ditzel is Professor and Chair of the Medical Biotechnology Center at the University of Southern Denmark and a Consultant in the Department of Oncology at Odense University Hospital, Odense, Denmark.,

    Henrik J Ditzel & Maria B Lyng

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  1. Henrik J Ditzel
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  2. Maria B Lyng
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Correspondence to Henrik J Ditzel.

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Ditzel, H., Lyng, M. Advantages of multiple clinical tests for determining the optimum treatment strategy for ER-positive breast cancer. Nat Rev Clin Oncol 5, 376–377 (2008). https://doi.org/10.1038/ncponc1139

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