Adding Adjuvant Tamoxifen to Chemotherapy Harmful in Some Patients - Brief Article - Statistical Data Included

Family Pratice News,  Feb 1, 2000  

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SAN ANTONIO -- The survival impact of adding tamoxifen to postsurgical chemotherapy in patients with high-risk, lymph node-- negative breast cancer varies greatly depending upon menopausal and hormone receptor status, Dr. Laura Hutchins said at a breast cancer symposium sponsored by the San Antonio Cancer Institute.

The benefit of adding tamoxifen in this setting is greatest in postmenopausal women with hormone receptor--positive breast cancer.

But giving tamoxifen to premenopausal hormone receptor--negative patients actually appears to lead to worse survival than with postsurgical chemotherapy alone, said Dr. Hutchins of the University of Texas in San Antonio.

"This should cast doubt on any assumption that tamoxifen in premenopausal patients could not be harmful," she said.

Dr. Hutchins presented data from a prospective multicenter trial in which 2,691 women with high-risk node-negative breast cancer underwent surgery followed by chemotherapy with or without 5 years of tamoxifen. The patients were deemed high risk because their tumors were at least 2 cm in size, were estrogen- or progestin-receptor positive, or had a high fraction of tumor cells in S-phase.

In postmenopausal women with hormone receptor--positive breast lesions, the addition of tamoxifen resulted in a 5-year disease-free survival of 86%, which was significantly better than the 76% rate in those who did not take tamoxifen. Overall survival also was better with tamoxifen, by a margin of 93% to 89%.

Premenopausal patients with hormone receptor--negative tumors had a 5-year disease-free survival of 82% with tamoxifen versus 88% with chemotherapy alone. Overall survival was 89% with tamoxifen and 94% without it.

This subset analysis based upon menopausal status was not part of the original study design, so the results must be considered exploratory But the findings suggest that oncologists should be selective in using tamoxifen, she said.

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