Leuprolide, one such agent, may also directly inhibit breast cancer growth in addition to suppressing FSH release. All patients, both premenopausal and postmenopausal, who relapse after an initial response to any hormone therapy become candidates for further additive or ablative forms of hormone treatment. Premenopausal women who initially improve with tamoxifen but subsequently experience relapse become candidates for oophorectomy. Aminoglutethimide plus hydrocortisone, or other aromatase inhibitors, is becoming a preferred therapy for premenopausal women after oophorectomy. However, oophorectomy should still be considered as a treatment for breast cancer relapse in premenopausal women who have had a prior favorable response to tamoxifen.
Many chemotherapeutic agents can produce objective responses in such patients.
In contrast to hormone therapy, there are few indicators that can be used to determine which patients who develop metastases will respond to chemotherapy on initial administration. As with hormone manipulations, the most responsive site of involvement with chemotherapy is soft tissue. However, life-threatening complications such as hepatic dysfunction and respiratory compromise associated with liver or lung metastases are generally more responsive to chemotherapy than to hormone therapy. In general, combination drug programs, rather than single-agent chemotherapy, are the initial treatments of choice when chemotherapy is indicated for patients with metastatic breast cancer. When compared with results of single-agent chemotherapy, the objective response and duration of response to combination chemotherapy are usually superior.