© 2000 by Oxford University Press
Journal of the National Cancer Institute, Vol. 92, No. 24, 2040-2041,
December 20, 2000
© 2000 Oxford University Press
CORRESPONDENCE |
Re: Combined Treatment With Buserelin and Tamoxifen in Premenopausal Metastatic Breast Cancer: a Randomized Study
Correspondence to: Trevor J. Powles, Ph.D., F.R.C.P., Breast Unit, Common Cancer Division, Royal Marsden Hospital, Sutton, Surrey SM2 5PT, U.K.
The results of the trial of combination endocrine therapy using buserelin and tamoxifen compared with buserelin alone or tamoxifen alone reported by Klijn et al. (1) shows a clear-cut improvement in objective response rate and survival for the combination. As highlighted in the accompanying editorial by Davidson (2), this has important implications for further metastatic adjuvant and chemoprevention trials of endocrine therapy. However, I would like to support the caution raised in the editorial about the interpretation of these results because of the lack of crossover in the design.
Many years ago, we undertook a similar trial of endocrine therapy in 222 postmenopausal women that involved tamoxifen, aminoglutethimide with hydrocortisone, and danazol given in combination or sequentially (3). Although we had a statistically significantly (P = .05; two-sided test) higher response to the combination (43%) compared with tamoxifen (31%) and the time to achieve response was faster for patients on the combination, the duration of response for responders was the same in both groups. Furthermore, after second- and third-line endocrine therapy, the total number of responses was the same in both groups and the total endocrine remission duration and survival were the same in both groups. Our conclusion at that time was that, despite an improved initial response rate, combination endocrine therapy did not provide added clinical benefit over use of these treatments sequentially in postmenopausal women.
It is obviously encouraging that the trial by Klijn et al. showed a survival advantage for the combination treatment, but it would be important to know that this was not because of denial of potentially beneficial second-line endocrine therapy to patients in the control arms.
Therefore, in adjuvant and chemoprevention trials, it may be important to compare combinations of tamoxifen and other hormone treatments with the same hormones given sequentially for the same total duration to identify clinical benefit for the whole group.
REFERENCES
1
Klijn JG, Beex LV, Mauriac L, van Zijl JA, Veyret C, Wildiers J, et al. Combined treatment with buserelin and tamoxifen in premenopausal metastatic breast cancer: a randomized study. J Natl Cancer Inst 2000;92:903–11.
2
Davidson NE. Combined endocrine therapy for breast cancer—new life for an old idea? [editorial]. J Natl Cancer Inst 2000;92:859–860.
3 Powles TJ, Ashley S, Ford HT, Gazet JC, Nash AG, Neville AM, et al. Treatment of disseminated breast cancer with tamoxifen, aminoglutethimide, hydrocortisone, and danazol, used in combination or sequentially. Lancet 1984;1:1369–73.[Medline]cancerlit;84244664
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||