Concomitant Chemo-hormonal therapy

I have been searching for information on whether or not to continue on an aromatase inhibitor while undergoing chemo. It seems that old data on tamoxifen indicted that it should not be given concomitantly with chemo. These are the studies that showed that tamoxifen should be given sequentially after chemo:
Osborne CK. Interactions of tamoxifen with cytotoxic chemotherapy for breast cancer. In: Jordan VC, editor. Long term tamoxifen for breast cancer. The University of Wisconsin Press; 1994. p. 181e98.
Albain KS. Adjuvant chemo-endocrine therapy for breast cancer: combined or sequential? The Breast 2003;12:12.
Sertoli MR, Pronzato P, Venturini M, et al. A randomized study of concurrent versus sequential adjuvant chemotherapy and tamoxifen in stage II breast cancer. Proc ASCO 2002;21 [abs.182].
Pico C, Martin M, Jara C, et al. Epirubicin-cyclophosphamide adjuvant chemotherapy plus tamoxifen administered concurrently versus sequentially: randomized phase III trial in postmenopausal node-positive breast cancer patients. A GEICAM 9401 study Ann Oncol 2004;15:79e87

However this same set of data is not available for the aromatase inhibitors which work so differently than tamoxifen. In fact I found that there are studies currently addressing the issue if one should stay on an aromatase inhibitor while on chemo. I actually have found a small study which showed that chemo ancombined with an aromatase inhibitor was superior to just chemo:

Randomized Phase II Trial of Letrozole and Letrozole Plus
Low-Dose Metronomic Oral Cyclophosphamide As Primary
Systemic Treatment in Elderly Breast Cancer Patients
Alberto Bottini, Daniele Generali, Maria Pia Brizzi, Stephen B. Fox, Alessandra Bersiga, Simone Bonardi,
Giovanni Allevi, Sergio Aguggini, Giuliana Bodini, Manuela Milani, Rossana Dionisio, Claudio Bernardi,
Arianna Montruccoli, Paolo Bruzzi, Adrian L. Harris, Luigi Dogliotti, and Alfredo Berruti
A B S T R A C T
Purpose
To investigate the activity of letrozole plus/minus oral metronomic cyclophophamide as primary
systemic treatment (PST) in elderly breast cancer patients.
Methods
One hundred fourteen consecutive elderly women with T2-4 N0-1 and estrogen receptor–
positive breast cancer were randomly assigned to primary letrozole therapy (2.5 mg daily for 6 months) or a combination of letrozole plus oral cyclophosphamide (50 mg/daily for 6 months) in an open-labeled, randomized phase II trial. Tumor response was assessed clinically, and
tumor Ki67 index and vascular endothelial growth factor (VEGF) -A levels were measured before and after treatment.
Results
Overall response rate was 71.9% (95% CI, 60.0 to 83.8) in the 57 patients randomly assigned to receive primary letrozole and 87.7% (95% CI, 78.6 to 96.2) in the 57 patients randomly assigned to receive letrozole plus cyclophosphamide. The difference in activity between treatment arms was predominantly confined to patients with ductal histology. There was a significantly greater
suppression of Ki67 and VEGF-A expression in the letrozole/cyclophosphamide-treated group than
in the letrozole-treated group, leading to lower Ki67 and VEGF expression at post-treatment residual histology (P
.03 and P
.002, respectively).
Conclusion
Both letrozole and letrozole plus cyclophosphamide treatments appeared active as PST in elderly breast cancer patients. Metronomic scheduling of cyclophosphamide may have an antiangiogenetic effect and the combination of letrozole plus cyclophosphamide warrants testing in a
randomized phase III trial. J Clin Oncol 24:3623-3628. © 2006 by American Society of Clinical Oncology

So it appears from this study that starving the tumor of estrogen made it more suceptible to killing by the chemo.
If you Google this study you can print the full text of the article for free.

here also is an interesting article of combination therapy with femara :http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2001220/

I also came across a clinical trial addressing the issue of the utility of concomitmant aromatase inhibitor with chemo. So surely the question is not answered yet.

Just thought that I would share that info,
Natada