Chemotherapy tamoxifen combination

Rll. Rutqvist, L. E., Cedermark, B., Glas, U., Johansson, H., Rotstein, S., Skoog, L., Somell, A., Theve, T., Wilking, N., Ashergren, J., and Hjalmar, M.-L., Randomized trial of adjuvant tamoxifen combined with postoperative radiation therapy of adjuvant chemotherapy in postmenopausal breast cancer. Cancer (Philadelphia) 66, 89-96 (1989),... 

Tamoxifen is on oestrogen-receptor antagonist. It is used in post-menopousol women with oestrogen-receptor-positive metastatic breast cancer at a dose of 20 mg doily. It con also be used in combination with chemotherapy. Severe side-effects ore infrequent however, it is associated with a small risk of endometrial cancer. Patients should be informed and reassured that the benefits of the treatment at this dose outweigh the risk. 

Tamoxifen is beneficial in postmenopausal women when used alone or when combined with cytotoxic chemotherapy. The present recommendation is to administer tamoxifen for 5 years of continuous therapy after surgical resection. Longer durations of tamoxifen therapy do not appear to add additional clinical benefit. Results from several randomized trials for breast cancer have established that adjuvant chemotherapy for premenopausal women and adjuvant tamoxifen for postmenopausal women are of benefit to women with stage I (node-negative) breast cancer. While this group of patients has the lowest overall risk of recurrence after surgery alone (about 35-50% over 15 years), this risk can be further reduced with adjuvant therapy. 

Rosenberg SA, Yang JC, Schwartzentruber DJ, Hwu P, Marincola FM, Topalian SL, Seipp CA, Einhorn JH, White DE, Steinberg SM. Prospective randomized trial of the treatment of patients with metastatic melanoma nsing chemotherapy with cisplatin, dacarbazine, and tamoxifen alone or in combination with interleukin-2 and interferon alfa-2b. J Clin Oncol 1999 17(3) 968-75. 

Dillman RO, Soori G, Wiemann MC, Schulof R, Dobbs TW, Ruben RH, DePriest CB, Church C. Phase II trial of subcutaneous in-terleukln-2, subcutaneous Interferon-alpha, intravenous combination chemotherapy, and oral tamoxifen in the treatment of metastatic melanoma final results of cancer biotherapy research group 94-11. Cancer Biother Radiopharm. 2000 Oct 15[5] 487-... 

Tamoxifen was shown to have a response and survival benefit in a randomized trial when combined with dacarbazine in patients with metastatic melanoma this benefit was most pronounced in women. Well designed prospective randomized studies demonstrate that tamoxifen does not significantly enhance the antitumor effect of dacarbazine alone or of the combination of dacarbazine with cisplatin and carmustine. As discussed previously, subsequent trials have not been able to confirm the initial reported benefit of the antiestrogen when combined with chemotherapy, and tamoxifen is no longer routinely included in chemotherapy regimens. 

Conley, B.A., Ramsland, T.S., Sentz, D.L., Wu, S., Rosen, D.M., Wollman, M. and Eiseman, J.L. (1999) Antitumor activity, distribution, and metabolism of 13-cis-retinoic add as a single agent or in combination with tamoxifen in established human MCF-7 xenografts in mice. Cancer Chemotherapy and Pharmacology, 43, 183—197. 

The effects of postoperative radiation therapy combined with adjuvant chemotherapy and tamoxifen therapy have been studied (Rll). The results indicated that postoperative radiation therapy played an important role in the primary management of postmenopausal women with high-risk breast cancer and that the addition of tamoxifen may further improve the results among ERP+ patients. There was a significant improvement in status in the ERP+ patients treated with tamoxifen and radiation therapy compared with women who received chemotherapy. There was also a trend toward improved overall survival. In contrast no benefit was observed among ERP- patients. It has been reported (B7, R3) that chemotherapy and tamoxifen improved the results achieved by chemotherapy alone, particularly in postmenopausal patients tamoxifen was particularly effective in patients with higher ERP content. Side effects were more numerous and more severe in patients receiving chemotherapy (with or without tamoxifen). These studies support the view that the choice of therapy for postmenopausal ERP+ breast cancer patients... 

R3. Rivkin, S., Green, S., Metch, B., Cruz, A., McDivitt, R., Knight, W., Glick, J., and Osborne, C. K., Adjuvant combination chemotherapy (CMFVP) vs tamoxifen (TAM) vs CMFVP+ TAM for postmenopausal women with ER+ operable breast cancer and positive axillary lymph nodes. Breast Cancer Res. Treat. 16(2), 145 (1990). 

Then five years ago in her late forties while going through a divorce, Susan discovered she had breast cancer. It was stage i with no lymph node involvement. She had a lumpectomy, radiation, and four rounds of combination chemotherapy with cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) plus antihormonal treatments of tamoxifen. 

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