Combining and Sequencing Adjuvant Chemotherapy and Tamoxifen in Postmenopausal Women with Node-Positive Breast Cancer

Abstract

Evaluation of: Albain KS, Barlow WE, Ravdin PM et al.; Breast Cancer Intergroup of North America: Adjuvant chemotherapy and timing of tamoxifen in postmenopausal patients with endocrine-responsive, node-positive breast cancer: a Phase 3, open-label, randomised controlled trial. Lancet 374(9707), 2055–2063 (2009). This Phase III trial randomized 1477 postmenopausal women with hormone receptor-positive, node-positive operable breast cancer to receive 5 years of adjuvant tamoxifen alone, or tamoxifen given concurrently or after cyclophosphamide, doxorubicin and fluorouracil (CAF) chemotherapy. After 13 years of follow-up, the 10-year disease-free survival was significantly improved in the group receiving the combination of CAF chemotherapy and tamoxifen, compared with the tamoxifen-alone group (57 vs 48%, respectively; p = 0.002); overall survival was also marginally improved in the combination group (65 vs 60%; p = 0.0057). Sequential tamoxifen given after CAF chemotherapy marginally improved disease-free survival compared with concurrent tamoxifen and chemotherapy (60 vs 53%, respectively; p = 0.057). Chemotherapy with CAF together with sequential tamoxifen is a more effective adjuvant therapy for postmenopausal women with hormone receptor-positive, node-positive breast cancer compared with tamoxifen alone.