Faculty Bibliography

PIP: The prolonged administration of large doses of medroxyprogesterone acetate (MPA) in the treatment of patients with disseminated breast cancer was studied. The patients consisted of 17 postmenopausal women previously treated with 1 or more hormones (group I), 17 women (oophorectomized or postnatural menopause) who had received MPA prior to the study (group II), and 2 males with breast carcinoma (group III). Patients received MPA intramuscularly (as Depo-Provera, 100 mg 3 times weekly, 34 patients) or orally (as Provera, 100 mg daily, 2 patients), in all except 4 cases for a minimum of 5 weeks. Patients were classified as showing objective tumor regression or as being treatment failures. 4 patients, because of treatment for neurological complications, were judged not evaluable. 5 group-I patients and 2 group-II patients (both greater than 10 years since menopause) experienced objective tumor regression. All 7 patients received the MPA parenterally. By the end of the study mean duration of the objective remissions was 12 months. 3 of the 7 patients continued in remission at writing, 2 had succumbed to the disease, and 2 were receiving other agents. Site of involvement in these patients was predominantly osseous (3), visceral (2), or soft tissue (2). Mean age of the 7 responders was 69. The mean "free interval" from initial therapy to clinical appearance of distal metastases was 44 months in the responders. All 5 patients from group I had benefited from previous hormonal alterations. Of 10 patients receiving estrogens in combination with MPA immediately after the course of MPA alone, 5 demonstrated objective tumor regression, 1 who had responded to MPA alone. The best response in this group occurred in a 61-year old man. Most patients had no untoward effects with MPA administration. A fairly extensive discussion of the literature on MPA is included.