A systematic review 1 including 28 studies was abstracted in DARE.
In chemo-endocrine versus endocrine therapy alone, 7 of 11 trials (n=7301) with node-positive tumours, reported an advantage in disease-free survival for the combined modality therapy. In the subset of node-negative tumours, 1 trial reported an advantage of the combination. In chemo-endocrine versus chemotherapy alone (18 trials, n=8,965), 13 trials produced no evidence of benefit, although in 3 of them subgroups had evidence of benefit, and 5 trials demonstrated an advantage for combined therapy.
A meta-analysis of RCTs 2 comparing concurrent or sequential administration of adjuvant chemotherapy (CT) and endocrine therapy (ET) included 3 trials with a total of 2021 hormone-receptor positive early stage breast cancer patients. Overall, 755 disease-free survival events were observed, 365 in the sequential arm and 390 in the concomitant arm, with a pooled HR of 0.95 (95% CI 0.76 to 1.18, P=0.643). No association between timing of treatment and overall survival was observed (HR 0.95; 95% CI 0.80 to 1.12, P=0.529).
Comment: The quality of evidence is downgraded by severe limitations in review methodology.
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