To the Editor: In their Perspectives on Care at the Close of Life article, Dr Abrahm and colleagues1 discussed management of spinal cord compression in patients with advanced metastatic cancer. On reading the patient's story, it seems that a patient with regression of a left hip metastasis following treatment in 1990 with salpingo-oophorectomy would be a candidate for another hormonal therapy in 2000 when a new vertebral metastasis developed or in 2004 when further surgery was required. The authors did not comment on why tamoxifen or an aromatase inhibitor was not initiated at those times, although there is evidence that patients who respond to 1 hormonal maneuver have a high likelihood of responding to a second and even a third.2
Pritchard KI. Antihormone Therapy in Recurrent Metastatic Breast Cancer. JAMA. 2008;299(23):2745. doi:10.1001/jama.299.23.2745-a
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