Dr. Pritchard has received honoraria and served as a member of the advisory board for Aegera, AstraZeneca, Hoffmann-LaRoche, Novartis, Ortho-Biotech (advisory board only), Pfizer, Sanofi-Aventis, and YM Biosciences. She has also served as a consultant for AstraZeneca, Biomira, Hoffmann-LaRoche, Novartis, Ortho-Biotech, Pfizer, Sanofi-Aventis, and YM Biosciences and has received research funding from Amgen, AstraZeneca, Bristol-Myers Squibb, the National Cancer Institute of Canada, Novartis, Ortho-Biotech, Pfizer, Sanofi-Aventis, and YM Biosciences. Dr. Pritchard also has provided expert testimony for AstraZeneca and Sanofi-Aventis.
Combining endocrine agents with chemotherapy: Which patients and what sequence?†
Article first published online: 10 DEC 2007
Copyright © 2007 American Cancer Society
Volume 112, Issue S3, pages 718–722, 1 February 2008
How to Cite
Pritchard, K. I. (2008), Combining endocrine agents with chemotherapy: Which patients and what sequence?. Cancer, 112: 718–722. doi: 10.1002/cncr.23189
Presented at Endocrine and Targeted Manipulation of Breast Cancer: Proceedings of the Sixth Cambridge Conference, Cambridge, Massachusetts, April 30-May 1, 2007.
- Issue published online: 18 JAN 2008
- Article first published online: 10 DEC 2007
- Manuscript Accepted: 11 OCT 2007
- Manuscript Revised: 4 OCT 2007
- Manuscript Received: 30 JUL 2007
- breast cancer;
- endocrine therapy;
- hormone therapy;
- aromatase inhibitors
In metastatic breast cancer, attempts to improve response to therapy by combining hormones and chemotherapy began in the 1970s. Since then, several randomized trials comparing single-agent hormone therapy or chemotherapy versus sequential combinations of these agents have been performed. In the majority of those studies, an increased response rate or an increased time to progression was observed when chemotherapy was added to hormone therapy or when hormone therapy was added to chemotherapy. However, in few of those trials was the increased response rate statistically significant or the response duration significantly prolonged, and no studies reported an improvement in overall survival. Furthermore, the studies did not make the correct comparisons of 1) hormone therapy alone followed by chemotherapy alone versus hormone therapy and chemotherapy given concurrently or 2) chemotherapy alone followed by hormone therapy versus concurrent chemotherapy and hormone therapy. To truly be advantageous, concurrent treatment should provide an increased response rate and response duration compared with the added or overall response rate and response duration of the same agents used sequentially. In the adjuvant setting, the timing and sequencing of hormone therapy and chemotherapy also has not been studied well. However, it has been accepted widely that adjuvant chemotherapy should be completed before beginning tamoxifen. No trials examining concurrent versus sequential treatment have been performed with hormone therapy and chemotherapy in the premenopausal setting or with aromatase inhibitors and chemotherapy in postmenopausal women. Considering the demonstrated importance of the timing of chemotherapy and tamoxifen in the postmenopausal setting, these questions should be explored further. Cancer 2008. © 2007 American Cancer Society.