Current status of post-chemotherapy tamoxifen in early breast cancer

In the 2 decades since tamoxifen entered clinical practice for breast cancer therapy, the clinical application of this agent has evolved from the treatment of metastatic disease, to systemic adjuvant therapy, and, recently, to the experimental application as a chemoprevention agent. The Early Breast Cancer Trialists' Collaborative Group metaanalysis provides compelling evidence of the benefits associated with the use of tamoxifen and chemotherapy as separate adjuvant modalities in women with stages I and II breast cancer. The role of the combined use of chemotherapy and tamoxifen in this analysis, however, is less certain. Since chemotherapy and tamoxifen therapy have the potential for life-threatening toxicities, a critical appraisal of the available literature is needed to determine which patient populations would receive additional benefit from combined adjuvant chemotherapy and tamoxifen and which questions still need to be addressed in clinical trials.