Combining Hormonal Therapy w/Chemotherapy for Advanced Breast Cancer

For advanced breast cancer, mets to bones and lymphangitic spread to lungs, what do you think of combining Femara with Adriamycin at the same time (or combining any hormonal drug w/any chemo drug)?  Pros and cons, please.  Thanks very much.

[CCF-RN,MSN-rf]

Dear query:  Most of the research to date looks at the use of combining tamoxifen with chemotherapy - and combination often refers to using the hormone after the chemotherapy.  The conclusion is that if the woman is menopausal after the chemo (whether she was before or whether chemo put her into menopause) AND if she is estrogen receptor positive.  There is benefit to adding tamoxifen.  If she is premenopausal, tamoxifen may have less benefit.  In either case using tamoxifen applied to women who's tumors are estrogen receptor positive.  Chemotherapy often shuts down the ovaries - accomplishing a reduction in estrogen.  The addition of aromatase inhibitors to chemotherapy has not been well researched.  However, aromatase inhibitors have been approved as first line therapy for POST menopausal women with estrogen receptor positive metastatic disease.  Adding hormones would probably not hurt (as they are fairly well tolerated).  The question is, will it help.  You should discuss this with your physician (hopefully a breast cancer specialist) who can evaluate your options in the context of your situation.

[iduj]

Thank you very much for your very quick reply.  Unfortunately, I am having difficulty interpreting it because of your statement that "and combination often refers to using the hormone after the
chemotherapy."  So, do I assume that the remainder of your answr means hormonal therapy AFTER chemotherapy OR hormonal therpay WITH chemotherapy?  Also, I was considering Femara as hormonal therapy. I realize it is an aromatase inhibitor and thus perhaps NOT a hormone.  So -- is the bottom line that taking Femara AT THE SAME TIME as a chemotherapy probably won't hurt, but may not help?  Thanks again for all of your help.  It is much appreciated!