Sequential endocrine therapy and chemotherapy in metastatic breast cancer: effects on survival

Follow-up data of 113 patients with stage IV breast cancer treated with the antiestrogen tamoxifen show that the duration of remission is in average in excess of 21 months with a median of 16 months. Survival from start of antiestrogen therapy was significantly longer in patients who responded to tamoxifen, in those with dominant site of disease in the soft tissue, and in those with less extensive metastatic involvement. Overall survival from onset of metastasis was also much longer in patients who had responded to tamoxifen than in those who had failed (median of 52 and a half months vs 23 months). Hypophysectomy and androgen therapy used sequentially after antiestrogen each induced further remissions in almost half of the patients with a median duration of 16 months and 10 months respectively. Five drug chemotherapy used in most patients after maximum benefit had been obtained with endocrine therapy induced remissions in two-thirds of the patients with a median duration of 8 months. Adriamycin used sequentially as a single agent induced significant further palliation in almost half of the patients with a median duration of 4 and a half months. We conclude that sequential endocrine therapy and chemotherapy is highly effective in the treatment of stage IV breast cancer and offers prolonged survival to patients with hormone responsive tumors.