J Gastric Cancer 2011;11(3):180-184 http://dx.doi.org/10.5230/jgc.2011.11.3.180 Case Report An Effect of Letrozole on Gastric Cancer? Ahmed EL Hadi, Hazem AL-Momani, and Paul Edwards Department of General Surgery, Aneurin Bevan Healthcare NHS Trust Nevill Hall Hospital, Wales, United Kingdom Letrozole is a drug used in the treatment of postmenopausal women with breast and ovarian tumours. There is no evidence in the lit- erature indicating its use in treating gastric cancer. We present a 68 year old lady admitted from the emergency department with weight loss, malaise and anaemia. Investigations confirmed the presence of two different primary tumours in the left breast and the stomach. Following that this patient with oestrogen receptor positive breast cancer and oestrogen receptor negative gastric cancer was treated with letrozole for her breast cancer followed by a gastric resection. Independent histology by two pathologists pre-operatively diagnosed gastric adenocarcinoma. Post-operatively, independent analysis of the resected stomach, omentum and lymph nodes revealed no evidence of gastric cancer. Therefore we conclude that there is a possibility of letrozole having an effect on gastric cancer. Further studies are needed. Key Words: Letrozole; Stomach neoplasms; Remission, spontaneous Aromatase inhibitors (AI) are a class of drugs used in the treat- menopausal women.(3,4) Introduction 1. Letrazole ment of breast and ovarian cancer in postmenopausal women. Estrogen has a great role on the progression of breast cancer, and studies have shown that exposure to estrogens increases the risk is produced in the ovaries and letrozole is ineffective. Randomized clinical trials have demonstrated the clinical benefits of letrozole across the spectrum of hormone-responsive breast cancer in post- 2. Differentiating primary gastric cancer from meta- static breast cancer to stomach of breast cancer(1) therefore therapeutic agents targeting estrogen It may be very difficulty to differentiate between primary gastric synthesis & Estrogen receptors have made a huge difference to the tumours from metastatic breast cancer to the stomach on clini- treatment of breast cancer. Letrozole is a very potent and selective cal, endoscopic, radiological and histopathological features(5,6) AI that leads to the inhibition of the enzyme activity of intracel- detailed immunohistochemical analysis may be the only consistent lular aromatase at the major sites where it is found.(2) Aromatase is method for differentiating between metastatic and primary gastric expressed primarily in the ovary and also in central and peripheral carcinoma. Although oestrogen and progesterone receptor positiv- tissues, fat, muscle, liver, and breast. Letrozole is only effective in ity in the gastric biopsies suggest breast cancer metastasis to the postmenopausal women in whom estrogen is produced predomi- stomach, it is worth noting that oestrogen and progesterone recep- nantly by the adrenals. Whilst in premenopausal women estrogen tor positivity have been reported in 32% and 12% of patients with Correspondence to: Ahmed EL Hadi Department of General Surgery, Nevill Hall Hospital, Brecon Road, Abergavenny, Wales, United Kingdom, NP7 7EG Tel: +01873 732503, Fax: +01873 732746 E-mail: ahmed.elhadi@gmail.com Received June 29, 2011 Revised September 15, 2011 Accepted September 15, 2011 primary gastric cancer.(7) However, these findings are based upon studies using first-generation antibodies against Oestrogen receptor β (ERβ) which are no longer used in standard practice. Taal et al investigated whether immunohistochemical detection with second- generation antibodies against Oestrogen receptor α (ERα) can be used to diagnose gastric metastasis of breast carcinoma(8) and they This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/3.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyrights © 2011 by The Korean Gastric Cancer Association www.jgc-online.org