Mature results of a randomized phase II multicenter study of exemestane versus tamoxifen as first-line hormone therapy for postmenopausal women with metastatic breast cancer.

BACKGROUND: Women with hormone-responsive metastatic breast cancer (MBC) may respond to or have stable disease with a number of hormone therapies. We explored the efficacy and safety of the steroidal aromatase inactivator exemestane as first-line hormonal therapy in MBC in postmenopausal women. PATIENTS AND METHODS: Patients with measurable disease were eligible if they had received no prior hormone therapy for metastatic disease and had hormone receptor positive disease or hormone receptor unknown disease with a long disease-free interval from adjuvant therapy. They were randomized to tamoxifen 20 mg/day or exemestane 25 mg/day in this open-label study. RESULTS: Blinded independently reviewed response rates for exemestane and tamoxifen were 41% and 17%, respectively. Fifty-seven per cent of exemestane- and 42% of tamoxifen-treated patients experienced clinical benefit, defined as complete or partial response, or disease stabilization lasting at least 6 months. There was a low incidence of severe flushing, sweating, nausea and edema in women who received exemestane. One exemestane-treated patient had a pulmonary embolism with grade 4 dyspnea. CONCLUSIONS: Exemestane is well tolerated and active in the first-line treatment of hormone-responsive MBC. An ongoing EORTC phase III trial is comparing the efficacy, measuring time-to-disease progression, of exemestane and tamoxifen.

No evidence of host specialization in a parasitic pea-crab exploiting two echinoid hosts

The pinnotherid crab Dissodactylus primitivus lives parasitically on 2 burrowingechinoid species, Meoma ventricosa and Plagiobrissus grandis. The fecundity of female crabsvaries between hosts, and is higher when parasitizing P. grandis than M. ventricosa. Moreover, thehosts present great variations in morphology (size and density of spines). These characteristicssuggest the potential to differentiate crabs according to host species. We investigated the genetic(microsatellites) and morphometric (outline analysis) differentiation of this parasitic crab between2 host species at 1 Jamaican site (Western Lagoon, Discovery Bay), and compared it with geographicdifferentiation among 4 sites along the north coast of Jamaica. Greater genetic differencesbetween parasites of the 2 sympatric hosts than between parasites of a single host at different geographiclocations would indicate host differentiation. Genetic analyses (microsatellites) did notdetect spatial differentiation (probably due to local hydrography) or differentiation according tohost species. This lack of host differentiation could be explained by mobility of adult crabsbetween hosts. However, there was weak but significant morphological differentiation betweenfemale crabs from the 2 hosts. This morphological difference may reflect constraints due to hostmorphology.