Treatment of advanced male breast cancer.

The modalities used to treat 27 male patients with metastatic breast cancer at Memorial Hospital from 1957--1979 are reviewed. The overall objective orchiectomy response rate was 48% (11/23). The median response was 11 months (6--96 months). The median survival in responders was 58 months, whereas the median survival in orchiectomy failures was 24 months. Four patients had estrogen receptor protein determinations (ERP). Two positive ERP patients and one borderline ERP patient responded (18--34 months). One ERP-negative patient failed orchiectomy. The number of major ablations in this series (two responses/two adrenalectomies, two failures/two hypophysectomies) does not permit conclusions, although review of the literature suggests that major ablation may be valuable in patients responding to orchiectomy. Two of three patients who refused ablative therapy responded (three months, ten months) to single agent provera. Administering stilbesterol to the ten-month responder and to the patient who failed provera resulted in two additional responses (four months, continuing, and 22 months). Of six patients who failed orchiectomy and subsequently received chemotherapy, four patients responded (7--40 months). The median survival in these patients was 40 months (33--44 months). This review supports the importance of orchiectomy in the treatment of metastatic male breast cancer. Although the numbers are small, these data suggest that estrogen receptor determinations may be useful in selecting patients for orchiectomy. Selective additive hormone therapy may be useful in patients who refuse orchiectomy. Chemotherapy may provide worthwhile palliation in patients who fail orchiectomy.