Is Chemoendocrine Treatment without Alternative?

摘要

Current trial-based evidence is insufficient for answering the questions asked in the debate of this volume of Breast Care: (i) The optimal type and duration of endocrine therapy is ill-defined in these comparisons in the premenopausal setting [1,2,3] and has significantly further developed in the postmenopausal setting in the recent past [1, 4, 5]. (ii) None of the chemotherapy regimens of the overview data presented in direct comparisons of chemoendocrine versus endocrine therapy alone would nowadays be considered standard since they lacked taxanes and might be less efficient [6]. In fact, taxanes provided similar benefit in estrogen receptor (ER)+ve versus ER−ve patients independent of lymph node status [7, 8]. In addition, suboptimal dose intensities below 85% of even cyclophosphamide/methotrexate/5-fluorouracil (CMF) [9] and the lack of sufficient rates of neutropenia-reduced outcomes of patients compared to endocrine therapy alone make fair comparisons of often suboptimal endocrine therapy with also suboptimal chemo(endocrine) therapy difficult [10]. (iii) The trials usually compared chemotherapy with endocrine therapy, but there is not sufficient data from trials comparing chemotherapy plus tamoxifen with luteinizing hormone-releasing hormone (LHRH) analoga plus tamoxifen and LHRH analoga alone [1]. (iv) The relevant trials testing optimized modern endocrine therapy ± adequate chemotherapy in premenopausal patients like BIG 4–02 (Perche) and Promise have been closed prematurely due to slow patient recruitment.