What role for concurrent chemohormonal therapy in breast cancer?

After a hundred years of using hormonal therapy for the treatment of breast cancer, and developments since 1942 in chemotherapy, combining the two modalities seemed a logical next step. However, trials using tamoxifen plus cyclophosphamide, methotrexate, and 5-FU, or dibromodulcitol and doxorubicin with tamoxifen showed no improvement in survival, and considerable toxicity. But it was learned from these trials that breast cancers exhibit cellular heterogeneity with regard to estrogen-receptor status and that hormonal therapy and chemotherapy have different actions and toxicity. Also, cell cycle specific agents are most effective against rapidly dividing cells. Further trials utilizing these concepts are warranted, although routine use of combined chemohormonal therapy is not yet recommended.