Combination therapy of hormone and cytotoxic agents in advanced breast cancer

Abstract

The effectiveness of combination therapy with diethylstilbestrol, cyclophosphamide, and 5‐fluorouracil (DES + CTx + FU) was compared with DES alone or CTx + FU in 87 postmenopausal women with advanced breast cancer. Therapy was randomized according to the tumor estrogen‐receptor (ER) status. In 30 patients with ER‐rich tumors and 35 patients with ER‐unknown tumors, combination therapy yielded a higher response rate than DES therapy (87% vs. 64% and 59% vs. 23%, respectively). The pooled data from these two groups of patients suggest that the improved response rate from DES + CTx + FU against DES becomes more apparent in patients with visceral involvement (89% vs. 47%) (P 0.025) and that patients treated initially with combination therapy (DES + CTx + FU) appeared to have a longer survival than those treated with sequential therapy (DES + CTx + FU) (P = 0.06). The survival data in 22 patients with receptor‐poor tumors were significantly inferior to those with receptor‐rich tumors (P = 0.001). The ER status and presence of visceral metastases are significant factors in the selection of treatment programs.