Prevention of breast cancer recurrence with adjuvant cytotoxic
- 18 Downloads
The paper provides a brief summary of the scientific hypotheses underlying adjuvant trials of systemic treatment in primary breast cancer, the history of the first and second generation of adjuvant studies of cytotoxic and endocrine therapy, and a brief description of the main findings of the international overview of all available randomized trials of adjuvant systemic treatment. In short, the overview has provided conclusive evidence that both adjuvant endocrine therapy (ovarian ablation and tamoxifen) as well as cytotoxic polychemotherapy can prevent disease recurrence and prolong overall survival. However, the treatment benefit appears to be only moderate and may not be considered clinically worthwhile in some patient subsets, e.g. those with a relatively favourable outcome with local treatment alone. Refinements in the use of of prognostic factors to select patients for treatment — particularly in node-negative disease — are thus warranted, as well as further research aimed at improving treatment efficacy.
Key wordsBreast cancer Adjuvant therapy Chemotherapy Endocrine therapy
Unable to display preview. Download preview PDF.
- 2.Abram W P, Baum M. Berstock D Aet al.: Cyclophosphamide and tamoxifen as adjuvant therapies in the management of breast cancer. Preliminary analysis by the CRC Adjuvant Breast Trial Working Party.Br J Cancer 57, 604–607 (1988).Google Scholar
- 3.Ludwig Breast Cancer Study Group: Combination adjuvant chemotherapy for node-positive breast cancer. Inadequacy of a single perioperative cycle.N Engl J Med 319 677–683 (1988).Google Scholar
- 4.Davidson N E, Lippman M E: Adjuvant therapy for breast cancer, in Lippman M E, Lichter A S, Danforth D N (eds):Diagnosis and Management of Breast Cancer, pp. 348–374. Philadelphia, W B Saunders (1988).Google Scholar
- 5.Early Breast Cancer Trialists Collaborative Group (EBCTCG): Treatment of early breast cancer: world- wide evidence in 1985–1990. A systematic overview of all available randomized trials in early breast cancer of adjuvant endocrine and cytotoxic therapy.Treatment of Early Breast Cancer, Vol. 1. Oxford., Oxford University Press (1990).Google Scholar
- 8.Peto R: Overview of trials of adjuvant systemic therapy of early breast cancer. Paper read before the First International Conference of the European Society of Mastology, Venice (1991).Google Scholar
- 10.Cole M P: Suppression of ovarian function in primary breast cancer, in Forrest A P M, Kunkler P B (eds):Prognostic Factors in Breast Cancer, pp. 146–156. Edinburgh, E S Livingston (1968).Google Scholar
- 11.Nolvadex Adjuvant Trial Organisation. Controlled trial of tamoxifen as single adjuvant agent in management of early breast cancer. Analysis at six years by the Nolvadex Adjuvant Trial Organisation.Lancet i, 836–840 (1985).Google Scholar
- 12.Breast Cancer Trials Committee, Scottish Cancer Trials Office. Adjuvant tamoxifen in the management of operable breast cancer: the Scottish trial.Lancet ii. 171–175 (1987).Google Scholar
- 16.Rutqvist L E, Cedermark B, Glas U, Johansson H, Nordenskjöld B, Skoog L, Somell A, Theve T, Friberg S, Askergren A: The Stockholm trial on adjuvant tamoxifen in early breast cancer. Correlation between estrogen receptor level and treatment effect.Breast Cancer Res Treat 10, 255–266 (1987).CrossRefPubMedGoogle Scholar
- 22.Rutqvist L E, Cedermark B, Glas U, Mattsson A, Skoog L, Somell A, Theve N O, Wilking N, Askergren J, Hjalmar M-L, Rotstein S, Perbeck L, Ringborg U: Contralateral primaries among breast cancer patients included in a randomized trial of adjuvant tamoxifen.J natn Cancer Inst (in press)Google Scholar