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Effect of Tamoxifen After Chemotherapy in Hormone Receptor–Positive, Node-Negative Breast Cancer

Sir Mortimer B. Davis Jewish General Hospital, Montréal, Québec, Canada

To the Editor:

In the discussion of the article by Hutchins et al¹ it is stated that both the hazard ratios for disease-free survival and overall survival show a narrow advantage for cyclophosphamide, doxorubicin, and fluorouracil that was not as strong as had been hypothesized. Furthermore, it was stated that the two-sided statistical test was not statistically significant. Later in the discussion, it is stated that the benefit seen in hormone receptor–positive patients was dramatic. It is clear that the disease-free survival is 6% different in favor of tamoxifen in the hormone receptor–positive patients, but this difference appears to be largely due to a reduction in opposite breast recurrences. Moreover, the difference in overall survival is exactly the same as the difference between cyclophosphamide, methotrexate, and fluorouracil and cyclophosphamide, doxorubicin, and fluorouracil, which is 82% with no tamoxifen versus 85% with tamoxifen. There was a one-sided P test, which was significant, but there is no discussion of the two-sided P test. In fact, it appears that if you treat hormone-positive, node-negative breast cancer with chemotherapy the effect of tamoxifen on survival is minimal.

Author's Disclosures of Potential Conflicts of Interest

The author indicated no potential conflicts of interest.

REFERENCE

1. Hutchins LF, Green SJ, Ravdin PM, et al: Randomized, controlled trial of cyclophosphamide, methotrexate, and fluorouracil versus cyclophosphamide, doxorubicin, and fluorouracil with and without tamoxifen for high risk, node-negative breast cancer: Treatment results of Intergroup protocol INT-0102. J Clin Oncol 23:8313-8321, 2005[Abstract/Free Full Text]

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Related Reply

• In Reply:
  Laura F. Hutchins and Stephanie J. Green
  JCO 2006 24: 2392 [Full Text]

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