Tamoxifen, an oestrogen receptor-blocking agent widely used to treat breast cancer, has also been used, usually together with cytotoxic agents, and may modify the disease response to such drugs. An early study in 117 patients suggested a benefit for the addition of tamoxifen to single-agent dacarbazine (response rates 28% versus 12%, P= 0-03, median survival 48 weeks versus 29 weeks, P= 0-02).12 Again, this was not confirmed in a four-arm study in 258 patients with metastatic MM. Response rates were 19% (CI 12-26) for patients receiving tamoxifen and 18% in the non-tamoxifen group (CI 12-25).13

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