Estrogen receptors and breast cancer response to adrenalectomy.

Results of studies of receptor content of dependent rat mammary tumors suggested that an estimation of the receptor content of a breast cancer specimen might provide a valuable guide for predicting the response of that patient to ablative therapy. This investigation was undertaken both by patients with metastatic disease to correlate their response to adrenalectomy or hypophysectomy and of mastectomy patients to characterize the primary tumor for further correlation with the response to endocrine therapy should the cancer recur. Tumors were obtained as soon as possible after excision. Techniques methods and materials employed are given in detail. When slices of tumor were examined for estradiol affinity by the uptake-inhibition procedure they were found to fall into 2 classes: 1) those showing low uptake not depressed in the presence of nafoxidine or Parke-Davis CI-628 and 2) those showing a larger incorporation which was reduced by the inhibitor. A few showed a borderline pattern. Metastatic tumors presented similar patterns to primary tumors. Positive metastatic tumors usually showed a higher total level of estradiol incorporation than positive primary tumors. Based on the results of 51 mastectomy patients divided equally between positive and negative patterns with 2 borderline cases it is concluded that patients whose breast cancers lack the estrogen receptor substance have little chance of responding to endocrine therapy or ablative surgery. Some of those who possess estrogen-binding proteins will benefit from such treatment. It is possible that those with positive findings may have mixed metastases so that the negative metastases will be unresponsive. False positive reactions may lead to futile treatment but false negative readings may cause omission of treatment that could lead to remissions. Subsequent to the original study additional patients have been added. Of a total of 84 primary tumors 39 showed the presence of an estrogen receptor 38 were negative and 7 were borderline. Of 40 metastatic tumors 12 were positive 25 negative 2 borderline and 1 with multiple metastases showed both positive and negative in different specimens. Of 58 patients with metastatic disease 42 had received some type of endocrine therapy. However 10 of 13 patients whose cancers contained estrogen receptors showed remission with endocrine therapy.