Molecular and pharmacological aspects of antiestrogen resistance

• Published in: Journal of steroid biochemistry and molecular biology Vol. 76; no. 1; pp. 71 - 84
• Main Authors: Clarke, Robert, Skaar, Todd C., Bouker, Kerrie B., Davis, Natalie, Lee, Y.Richard, Welch, James N., Leonessa, Fabio
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Oxford Elsevier Ltd 01-01-2001; Elsevier Science
• Subjects: Antiestrogen resistance; Biological and medical sciences; Cell Division - drug effects; Drug Resistance, Neoplasm; Estrogen Receptor Modulators - pharmacology; Estrogen Receptor Modulators - therapeutic use; Growth Substances - physiology; Hormones. Endocrine system; Medical sciences; Mitogen-Activated Protein Kinases - metabolism; Molecular aspects; Neoplasms, Hormone-Dependent - drug therapy; Neoplasms, Hormone-Dependent - enzymology; Neoplasms, Hormone-Dependent - metabolism; Neoplasms, Hormone-Dependent - pathology; Oxidative Stress; Pharmacological aspects; Pharmacology. Drug treatments; Receptors, Estrogen - metabolism; Receptors, Estrogen - physiology; Signal Transduction; steroid hormones; Tamoxifen - pharmacology; Tamoxifen - therapeutic use; Molecular aspects; Pharmacological aspects; Antiestrogen resistance; Mammary gland diseases; Target tissue resistance; Antiestrogen; Antihormone; Review; Mammary gland; Malignant tumor; Non steroid compound; Mechanism; Tamoxifene; Hormonal receptor
• ISSN: 0960-0760; 1879-1220
• DOI: 10.1016/S0960-0760(00)00193-X

Endocrine therapy is effective in approximately one-third of all breast cancers and up to 80% of tumors that express both estrogen and progesterone receptors. Despite the low toxicity, good overall response rates, and additional benefits associated with its partial agonist activity, most Tamoxifen-responsive breast cancers acquire resistance. The development of new antiestrogens, both steroidal and non-steroidal, provides the opportunity for the development of non-cross-resistant therapies and the identification of additional mechanisms of action and resistance. Drug-specific pharmacologic mechanisms may confer a resistance phenotype, reflecting the complexities of both tumor biology/pharmacology and the molecular endocrinology of steroid hormone action. However, since all antiestrogens will be effective only in cells that express estrogen receptors (ER), many mechanisms will likely be directly related to ER expression and signaling. For example, loss of ER expression/function is likely to confer a cross-resistance phenotype across all structural classes of antiestrogens. Altered expression of ERα and ERβ, and/or signaling from transcription complexes driven by these receptors, may produce drug-specific resistance phenotypes. We have begun to study the possible changes in gene expression that may occur as cells acquire resistance to steroidal and non-steroidal antiestrogens. Our preliminary studies implicate the altered expression of several estrogen-regulated genes. However, resistance to antiestrogens is likely to be a multigene phenomenon, involving a network of interrelated signaling pathways. The way in which this network is adapted by cells may vary among tumors, consistent with the existence of a highly plastic and adaptable genotype within breast cancer cells.