Molecular and pharmacological aspects of antiestrogen resistance

Robert Clarke, Todd C. Skaar, Kerrie B. Bouker, Natalie Davis, Y. Richard Lee, James N. Welch, Fabio Leonessa

Research output: Contribution to journalArticlepeer-review

94 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)71-84
Number of pages14
JournalJournal of Steroid Biochemistry and Molecular Biology
Issue number1-5
StatePublished - 2001
Externally publishedYes

Bibliographical note

Funding Information:
This work was supported in part by grants NIH R01-CA/AG58022, NIH P30-CA51008 and NIH P50-CA58185 (Public Health Service) and USAMRMC (Department of Defense) BC980629, BC980586 and BC990358.


  • Antiestrogen resistance
  • Molecular aspects
  • Pharmacological aspects


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