Rationale for combining tamoxifen and interferon in the treatment of advanced breast cancer.

Several investigators have discussed the possible combination of tamoxifen and interferon (IFN) in the treatment of breast cancer patients. The rationale in combining these drugs is that IFN induces the expression of estrogen receptors and therefore increases the sensitivity of breast cancer cells toward the growth-inhibitory activity of tamoxifen. In this paper we review the literature on the IFN-mediated expression of estrogen receptors and the postulated synergism of tamoxifen and IFN in the growth inhibition of breast cancer cell lines. Our results indicate that neither type I nor type II IFN increases the expression of estrogen receptors in MCF-7 cells. Together with tamoxifen both type I and type II IFN mediate additive but not synergistic growth inhibition of MCF-7 cells. On the basis of these results it is feasible to test tamoxifen and IFN as combined therapy in breast cancer patients. Preliminary clinical data show that the combination of 30 mg tamoxifen and 2 x 10(6) IU IFN-alpha as daily doses may induce WHO grade 3 leukopenia and thrombopenia in patients who are pretreated with polychemotherapy.