Cancer Treatment Today

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. There are methadone logical problems with the studies and the issue remains controversial.

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. Bedoghetti compared combined versus sequentia approaches. he concluded that no statistically significant differences in OS, DFS, and toxic effects between concurrent and sequential adjuvant chemo- and hormone therapies were observed.This study does not support the superiority of one schedule of chemo- and hormone-therapy administration over the other.

Kathleen I. Pritchard, Combining endocrine agents with chemotherapy: Which patients and what sequence?. Cancer Volume 112, Issue Supplement S3 1 February 2008 Pages 718722

Davide Bedognetti Mario Roberto Sertoli Paolo Pronzato Lucia Del Mastro Marco Venturini Paola Taveggia Elisa Zanardi Guido Siffredi Simona Pastorino Paola Queirolo, Concurrent vs Sequential Adjuvant Chemotherapy and Hormone Therapy in Breast Cancer: A Multicenter Randomized Phase III Trial. J Natl Cancer Inst (2011) 103 (20): 1529-1539.

NCCN. Breast Cancer 2017