[Chemotherapy and hormone therapy in breast carcinoma]

Both chemotherapy and hormonal therapy have been used in the adjuvant therapy of breast cancer to treat micrometastatic disease before it is clinically detectable. Several prospective, randomized trials consistently have demonstrated that disease-free survival can be significantly prolonged by the use of adjuvant chemotherapy. In some of these trials overall survival was increased as well. Premenopausal nodal-positive patients should receive adjuvant chemotherapy e.g. six cycles of CMF. Tamoxifen reduces overall tumor recurrence and mortality in postmenopausal estrogen receptor positive patients and to a lesser extent in estrogen receptor poor or negative patients. The effect of GnRh-analog for premenopausal patients with is currently investigated in multicentric studies. A response related strategy for management of metastatic breast cancer by hormonal manipulation and cytotoxic chemotherapy is outlined.