Chemotherapy and Tamoxifen for Breast Cancer

To the Editor: Fisher et al. compared the use of melphalan (lphenylalanine mustard) plus fluorouracil with the use of the antiestrogen tamoxifen plus melphalan and fluorouracil in a large trial of adjuvant therapy in 1863 women with primary breast carcinoma and positive axillary nodes.¹ Older women benefited from the addition of tamoxifen, whereas those below 49 years old had no substantial prolongation of disease-free survival. This finding raises two important biologic questions: How effective an antiestrogen is tamoxifen at the dose used (10 mg twice a day) in premenopausal patients? Does melphalan plus fluorouracil cause a”chemical oophorectomy” in premenopausal.