I needed to do this too - needed to be able to build two different versions of my app and wanted to be able to script the build using VCBUILD. VCBUILD does have the /override command line switch, but I am not sure it can be used to modify #define symbols that can then be tested using #if conditional compilation.
The solution I cam up with was to write a simple utility to create a header file that #defined the symbol based on the state of an environment variable and run the utility from a pre-build step. Prior to each execution of the VCBUILD step the script sets the environment variable and "touches" a file in the app to ensure that the prebuild step is executed.
Yes, it is an ugly hack, but it was the best I could come up with!