Efforts have been made to improve the efficacy of combination chemotherapeutic regimens for advanced breast cancer by integrating additive hormonal agents. Results with respect to the value of such an approach are conflicting, and the routine use of chemohormonal therapy in clinical practice has not been established. Further work in this area is needed, especially in regard to the use of hormonal agents as manipulators of tumor cell kinetics to enhance the effectiveness of chemotherapy. In addition, clinical trials have compared the results of hormonal therapy alone with those of chemohormonal therapy; currently, the use of hormonal agents alone seems to be preferable for the initial treatment of most postmenopausal women with advanced breast cancer. The exception to this practice would be in those patients who are clinically not candidates for hormonal therapy because of the site, extent, or tempo of disease or because of the absence of hormonal receptors.
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