Predictive indices of response

Given that hormone therapy is not effective in all tumours, indiscriminate application of treatment exposes patients with resistant cancer to the side-effects of endocrine-deprivation therapy and, more importantly, delays other potentially beneficial treatment.

Currently no marker correlates absolutely with endocrine dependency and the most widely-used predictor is the oestrogen receptor (ER), in relation to breast cancers. Between 60 and 75% of breast cancers are ER-positive by biochemical assay or immunohisto-chemistry; two-thirds of ER-positive tumours respond to hormone manipulation, compared with 5-10% of ER-negative tumours. The value of other markers such as the progesterone receptor in breast or endometrial cancer is less clear and measurement of the androgen receptor in prostatic cancer has not proved useful.

Previous response to hormone manipulation is a useful clinical predictor for second-line endocrine therapy and suggests that progression on hormone therapy does not equate with acquisition of absolute endocrine resistance.

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