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In the absence of men in most prospective randomised trials of breast cancer treatment, investigators have mostly reverted to propensity score matching in an attempt to balance prognostic variables and compare adjuvant therapies. In uncontrolled trials comparing tamoxifen with no tamoxifen, all showed better overall survival for the treated group. There has only been one randomised trial in which 56 MBC were treated for 6 months with either tamoxifen alone, tamoxifen +GnRHA or aromatase inhibitor (AI) plus GnRHa. After 6 months, E2 levels increased with tamoxifen but fell in those receiving GnRHA. Sexual function was unaffected with tamoxifen but impaired in those receiving GNRHa. Unfortunately, with tamoxifen there is a problem of compliance because of side-effects including hot flushes, decreased libido and erectile dysfunction causing discontinuation by 24% of cases. High-compliance with tamoxifen is cost-effective with a 99.70% probability compared with low adherence. Additionally however, there is an increase in cardiovascular events and non-cancer mortality which may be associated with adjuvant tamoxifen. Aromatase inhibitors plus GnRHA produce a three-fold increase in efficacy compared with AI alone. There is encouraging data from the monarcheE and NATALEE trials which included some males at risk of relapse who had adjuvant treatment including a cyclin-dependent kinase 4/6 inhibitor or placebo. There was significant improvement in invasive DFS in those given abemaciclib or ribociclib. From the SEER database 2010–2015, there were 514 MBC of whom 257 had chemotherapy and 257 who did not. Using propensity score matching, although there was significantly better OS after chemotherapy (97.5 versus 95%), breast cancer specific survival) was similar in both groups, After neoadjuvant chemotherapy pCR was less frequent in MBC compared with FBC (5–44% versus 10–63%). At present, neoadjuvant endocrine therapy for MBC remains largely untested. The addition of post-mastectomy radiotherapy appears to achieve slight improvement in overall survival. Patients who have undergone breast conserving therapy including breast irradiation had significantly improved OS compared with the unirradiated.

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Adjuvant Therapy of Male Breast Cancer

  • 章节

  • 发表日期：

    2025年

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  • Ian Fentiman

摘要

In the absence of men in most prospective randomised trials of breast cancer treatment, investigators have mostly reverted to propensity score matching in an attempt to balance prognostic variables and compare adjuvant therapies. In uncontrolled trials comparing tamoxifen with no tamoxifen, all showed better overall survival for the treated group. There has only been one randomised trial in which 56 MBC were treated for 6 months with either tamoxifen alone, tamoxifen +GnRHA or aromatase inhibitor (AI) plus GnRHa. After 6 months, E2 levels increased with tamoxifen but fell in those receiving GnRHA. Sexual function was unaffected with tamoxifen but impaired in those receiving GNRHa. Unfortunately, with tamoxifen there is a problem of compliance because of side-effects including hot flushes, decreased libido and erectile dysfunction causing discontinuation by 24% of cases. High-compliance with tamoxifen is cost-effective with a 99.70% probability compared with low adherence. Additionally however, there is an increase in cardiovascular events and non-cancer mortality which may be associated with adjuvant tamoxifen. Aromatase inhibitors plus GnRHA produce a three-fold increase in efficacy compared with AI alone. There is encouraging data from the monarcheE and NATALEE trials which included some males at risk of relapse who had adjuvant treatment including a cyclin-dependent kinase 4/6 inhibitor or placebo. There was significant improvement in invasive DFS in those given abemaciclib or ribociclib. From the SEER database 2010–2015, there were 514 MBC of whom 257 had chemotherapy and 257 who did not. Using propensity score matching, although there was significantly better OS after chemotherapy (97.5 versus 95%), breast cancer specific survival) was similar in both groups, After neoadjuvant chemotherapy pCR was less frequent in MBC compared with FBC (5–44% versus 10–63%). At present, neoadjuvant endocrine therapy for MBC remains largely untested. The addition of post-mastectomy radiotherapy appears to achieve slight improvement in overall survival. Patients who have undergone breast conserving therapy including breast irradiation had significantly improved OS compared with the unirradiated.