This trial, along with the crossover trials described above, demonstrated that sequential therapy with tamoxifen followed by an aromatase inhibitor is clearly more effective in preventing breast cancer events than tamoxifen alone.
Evidence-based medicine (UPKDS) has taught us that sequential therapy with metformin followed by sulfonylurea addition with subsequent insulin addition represents the treat to fail approach, and we do not recommend this approach unless cost is the overriding concern.
In a retrospective Italian study (n=34), third-line sorafenib after sequential therapy with sunitinib followed by everolimus or temsirolimus was associated with a median PFS of 4 months and a median overall survival of 7 months from initiation of sorafenib treatment (Di Lorenzo et al, 2010).
Inoue and colleagues evaluated the efficacy of sequential therapy with trastuzumab monotherapy followed by trastuzumab plus docetaxel after disease progression versus upfront combination therapy with trastuzumab and docetaxel as first-line therapy in patients with HER2+ metastatic BC.
Next, there is the possibility that patients received sequential therapy with both anti-HER2 agents by virtue of living longer, which may give rise to biased results.
Sequential therapy with short-course chemotherapy followed by rituximab has also been investigated in previously untreated patients (Rambaldi et al, 2002), and the results are similar to those for concurrent therapy.
Patients were treated with one of two treatment programs: sequential therapy with high-dose therapy consolidation or radioimmunotherapy followed by combination chemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisone.
After the evaluation by PET/CT, 20 patients were treated with multiple TKIs (9 sorafenib, 9 sunitinib, 2 sequential therapy with sorafenib and sunitinib, and 1 sequential therapy with sorafenib and IFN-α), and 6 patients underwent cytokine therapies.
Sequential therapy with VEGF-targeted therapy and mTOR inhibitors are currently the standard of care.
