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Tamoxifen reduces distant recurrence risk by HR 0.37 in PR-positive postmenopausal breast cancerTamoxifen Shows Long Term Benefit for Specific Breast Cancer Types

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Key Takeaway
Note that PR-positivity (threshold 10%) predicts significant long-term DRFI benefit from adjuvant tamoxifen therapy.

This secondary analysis of a randomized controlled trial evaluated 559 postmenopausal patients with lymph node-negative, ER-positive/HER2-negative breast cancer. Patients were assigned to either at least 2 years of adjuvant tamoxifen (40 mg once daily) or no endocrine therapy. The primary outcome was the 25-year distant recurrence-free interval (DRFI).

For patients with PR-positive disease (threshold of 10% or greater), the tamoxifen group achieved a DRFI of 85% compared to 68% in the control group (HR = 0.37; p <.0001; 95% CI [0.23-0.61]). In tumors with high PR gene expression, the DRFI was 84% for tamoxifen versus 66% for control (log-rank p <.001). A time-varying analysis for PR-positive disease up to 25 years also showed a treatment benefit (HR = 0.35; 95% CI [0.16-0.79]).

In contrast, no significant differences were observed in DRFI for PR-negative disease (79% vs. 70%, p =.14) or low PR gene expression (82% vs. 74%, p =.17). Safety and tolerability data were not reported. As a secondary analysis of the STO-3 trial, these findings suggest that immunohistochemistry-determined PR-positivity may predict long-term benefit from adjuvant tamoxifen in this specific patient population.

How this fits prior evidence

How this fits prior evidence: This finding extends the previous report that tamoxifen improves 20-year distant recurrence-free interval for Luminal A and B breast cancer. While the earlier data established a general benefit of tamoxifen for these subtypes, this study specifically identifies PR-positivity as a predictor for long-term benefit in lymph node-negative postmenopausal patients with ER-positive/HER2-negative tumors.

Researchers analyzed data from a large clinical trial involving 559 postmenopausal women with lymph node-negative breast cancer. The study looked at how the drug tamoxifen performed over a period of 25 years to see if it could prevent the cancer from returning.

The results showed that patients whose tumors had high levels of progesterone receptors (PR) saw a significant benefit from taking tamoxifen. In these specific cases, the rate of staying cancer-free was much higher for those on the medication compared to those who did not receive endocrine therapy. However, the study did not find a significant difference in outcomes for patients with low or no progesterone receptor levels.

Because this is a secondary analysis of an existing trial, it provides important information about long-term trends but should be viewed as part of a larger clinical picture. The findings suggest that certain markers can help predict how well tamoxifen works over many years. Patients should talk to their doctors to understand how these specific markers might affect their own treatment plans.

What this means for you:
Tamoxifen showed a significant 25-year benefit for patients with high progesterone receptor levels in their tumors.

Common questions

How long did the study follow patients to see results?

The study followed patients for a total of 25 years. This long-term timeframe allowed researchers to see how tamoxifen performed over decades rather than just a few years after diagnosis.

Who specifically benefited from the tamoxifen treatment?

The study found that patients with high progesterone receptor (PR) levels saw a significant benefit. Specifically, 85% of those on tamoxifen remained cancer-free compared to 68% in the group without endocrine therapy.

Does tamoxifen work for all types of breast cancer?

The study focused on postmenopausal women with lymph node-negative, ER-positive, and HER2-negative tumors. It specifically found that the benefit was linked to progesterone receptor levels.

Study Details

Study typeRct
EvidenceLevel 2
PublishedJul 2026
View Original Abstract ↓
We aimed to evaluate the long-term tamoxifen benefit by progesterone receptor (PR) levels in postmenopausal lymph node-negative breast cancer patients with estrogen receptor (ER)-positive/human epidermal growth factor receptor 2-negative (HER2) tumors in the STO-3 randomized trial. This is a secondary analysis of the STO-3 trial including 559 postmenopausal breast cancer patients by PR levels. Patients were randomly assigned to at least 2 years of adjuvant tamoxifen therapy (40 mg once daily) versus no endocrine therapy in the Stockholm (STO)-3 trial. Twenty-five-year distant recurrence-free interval (DRFI) was assessed by Kaplan-Meier, multivariable Cox proportional hazard regression, and multivariable time-varying analyses. Univariable Kaplan-Meier analysis showed a significant long-term tamoxifen benefit for PR-positive disease using a threshold of 10% or greater (DRFI, tamoxifen treated 85% vs. control 68%; p < .0001). Similarly, patients with high PR gene expressing tumors had a significant long-term tamoxifen therapy benefit (DRFI, tamoxifen treated 84% vs. control 66%; log-rank p < .001). In contrast, we report no significant therapy benefit for patients with PR-negative disease (DRFI, tamoxifen treated 79% vs. control 70%; log-rank p = .14) or low PR gene expression (DRFI, tamoxifen treated 82% vs. control 74%; log-rank p = .17). Multivariable Cox proportional hazard regression modelling confirmed the univariable findings for PR-positive disease (HR = 0.37; 95% CI [0.23-0.61]). Time-varying analysis revealed a treatment benefit for PR-positive disease up to 25 years (HR = 0.35; 95% CI [0.16-0.79]), but not for patients with PR-negative tumors. PR-positivity as determined by immunohistochemistry predicted long-term benefit from adjuvant tamoxifen in lymph node-negative postmenopausal breast cancer patients with ER+/HER2- tumors.
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