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Adjuvant Therapy for Early Breast Cancer in Pre-/Perimenopausal Women

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American Journal of Cancer

Abstract

The adjuvant treatment of pre- and perimenopausal breast cancer is an area of increasing importance as a result of the rising incidence of the disease and improvements in its detection and diagnosis. Recent years have seen a wider variety of treatments become available, presenting the possibility of increasingly individualized treatment regimens which provide benefits in terms of long-term survival and tolerability. Chemotherapy has been shown to provide a clear benefit to pre-/perimenopausal women with breast cancer, in particular the combination of cyclophosphamide, methotrexate, and fluorouracil (CMF), or more recently, anthracycline-containing regimens such as cyclophosphamide, doxorubicin, and fluorouracil (CAF). Trials examining the use of adjuvant taxanes have not shown a clear benefit so far compared with standard regimens. Adjuvant endocrine treatment has proved to be important in treating pre-/perimenopausal women with estrogen receptor positive tumors, providing clear evidence that treatment with tamoxifen for a period of 5 years is highly effective. Ovarian ablation has been shown to provide improvements in both overall and disease-free survival that are comparable to those provided by chemotherapy in hormone-sensitive patients whilst offering an improved tolerability profile compared with chemotherapy. Currently, evidence supporting the role of endocrine therapy combined with chemotherapy is limited. The increasing range of adjuvant treatment options available for pre-/perimenopausal breast cancer requires that patients be assessed individually to identify the most appropriate treatment option and that tolerability issues be discussed with the patient prior to the initiation of treatment.

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References

  1. Edwards BK, Howe HL, Ries AG, et al. Annual report to the nation on the status of cancer, 1973–1999, featuring implications of age and aging on US cancer burden. Cancer 2002; 94: 2766–92

    Article  PubMed  Google Scholar 

  2. Theriault RL, Sellin RV. Estrogen-replacement therapy in younger women with breast cancer. J Natl Cancer Inst Monogr 1994; 16: 149–52

    PubMed  Google Scholar 

  3. Rutqvist LE. Controversial issues in adjuvant systemic therapy of early breast cancer. Acta Oncol 1998; 37: 421–30

    Article  CAS  PubMed  Google Scholar 

  4. Osborne CK, Ravdin PM. Adjuvant systemic therapy of primary breast cancer. In: Harris JR, editor. Diseases of the breast. Philadelphia (PA): Lippincott Williams & Williams, 2000: 599–632

    Google Scholar 

  5. Pujol P, Duares JP, Tezenas S, et al. Changing estrogen and progesterone receptor patterns in breast carcinoma during the menstrual cycle and menopause. Cancer 1998; 83: 698–705

    Article  CAS  PubMed  Google Scholar 

  6. Bines J, Oleske DM, Cobleigh MA. Ovarian function in premenopausal women treated with adjuvant chemotherapy for breast cancer. J Clin Oncol 1996; 14: 1718–29

    CAS  PubMed  Google Scholar 

  7. Early Breast Cancer Trialists’ Collaborative Group. Ovarian ablation for early breast cancer: overview of the randomized trials. Lancet 1996; 348: 1189–96

    Article  Google Scholar 

  8. Early Breast Cancer Trialists’ Collaborative Group. Tamoxifen for early breast cancer: an overview of the randomized trials. Lancet 1998; 351: 1451–67

    Article  Google Scholar 

  9. Early Breast Cancer Trialists’ Collaborative Group. Polychemotherapy for early breast cancer: an overview of the randomized trials. Lancet 1998; 352: 930–42

    Article  Google Scholar 

  10. Tan AR, Swain SM. Adjuvant chemotherapy for breast cancer: an update. Semin Oncol 2001; 28: 359–76

    Article  CAS  PubMed  Google Scholar 

  11. Rodenhuis S, Bontenbal M, Beex LVAM, et al. Randomized phase III study of high-dose chemotherapy with cyclophosphamide, thiotepa and carboplatin in operable breast cancer with 4 or more axillary lymph nodes [abstract 286]. Proc Am Soc Clin Oncol 2000; 19: 75a

    Google Scholar 

  12. Peters W, Rosner G, Vredenburgh J, et al. A prospective, randomized comparison of two doses of combination alkylating agents (AA) as consolidation after CAF in high-risk primary breast cancer involving ten or more axillary lymph nodes (LN): preliminary results of CALGB 9082/SWOG 9114/NCIC MA-13 [abstract 2]. Proc Am Soc Clin Oncol 1999; 18: la

    Google Scholar 

  13. Bergh J, Wiklund T, Erikstein B, et al. Tailored fluorouracil, epirubicin, and cyclophosphamide compared with marrow-supported high-dose chemotherapy as adjuvant treatment for high-risk breast cancer: a randomised trial. Lancet 2000; 356: 1384–91

    Article  CAS  PubMed  Google Scholar 

  14. Stadtmauer EA, O’Neill A, Goldstein LJ, et al. Conventional-dose chemotherapy, compared with high-dose chemotherapy plus autologous hematopoietic stem-cell transplantation for metastatic breast cancer. N Engl J Med 2000; 342: 1069–76

    Article  CAS  PubMed  Google Scholar 

  15. Berry DA, Broadwater G, Klein JP, et al. High-dose versus standard chemotherapy in metastatic breast cancer: comparison of Cancer and Leukaemia Group B trials with data from the autologous blood and marrow transplant registry. J Clin Oncol 2002; 20: 743–50

    Article  CAS  PubMed  Google Scholar 

  16. McCarthy NJ, Swain SM. Update on adjuvant chemotherapy for early breast cancer. Oncology (Huntingt) 2000; 14: 1267–80

    CAS  Google Scholar 

  17. Lohrisch C, Di Leo A, Piccart MJ. Optimal adjuvant cytotoxic therapy for breast cancer. Breast 2001; 10: 106–13

    Google Scholar 

  18. Henderson IC, Berry D, Demetri G, et al. Improved disease-free and overall survival from the addition of sequential paclitaxel but not from the escalation of doxorubicin dose level in the adjuvant chemotherapy of patients with node-positive primary breast cancer [abstract 390]. Proc Am Soc Clin Oncol 1998; 17: 101a

    Google Scholar 

  19. Piccart J, Lohrisch C, Duchateau L, et al. Taxanes in the adjuvant treatment of breast cancer: why not yet? J Natl Cancer Inst Monogr 2001; 30: 88–95

    Article  CAS  PubMed  Google Scholar 

  20. Thomas E, Buzdar A, Theriault R, et al. Role of paclitaxel in adjuvant therapy of operable breast cancer: preliminary results of prospective randomised clinical trial [abstract 285]. Proc Am Soc Clin Oncol 2000; 19: 74a

    Google Scholar 

  21. Shapiro CL, Recht A. Side effects of adjuvant treatment of breast cancer. N Engl J Med 2001; 344: 1997–2008

    Article  CAS  PubMed  Google Scholar 

  22. Hortobagyi GN, Buzdar AU, Marcus CE, et al. Immediate and long-term toxicity of adjuvant chemotherapy regimens containing doxorubicin in trials at M.D. Anderson Hospital and Tumor Institute. NCI Monogr 1986; 1: 105–9

    PubMed  Google Scholar 

  23. Seidman A, Hudis C, Pierri MK, et al. Cardiac dysfunction in the trastuzumab clinical trials experience. J Clin Oncol 2002; 20: 1215–21

    Article  CAS  PubMed  Google Scholar 

  24. Tan-Chiu E, Piccart M. Moving forward: herceptin in adjuvant setting. Oncology 2002; 63Suppl. 1: 57–63

    Article  CAS  PubMed  Google Scholar 

  25. McKeage K, Perry CM. Trastuzumab: a review of its use in the treatment of metastatic breast cancer overexpressing HER2. Drugs 2002; 62: 209–43

    Article  CAS  PubMed  Google Scholar 

  26. Pienkowski T, Fumoleau P, Eiermann W, et al. Taxotere, cisplatin and herceptin (TCH) in first-line HER2 positive metastatic breast cancer (MBC) patients, a phase II pilot study by the Breast Cancer International Research Group (BCIRG 101) [abstract 2030]. Proc Am Soc Clin Oncol 2001; 20: 70b

    Google Scholar 

  27. Slamon DJ, Patel R, Northfelt R, et al. Phase II pilot study of herceptin combined with taxotere and carboplatin (TCH) in metastatic breast cancer (MBC) patients overexpressing the HER2-neu proto-oncogene: a pilot study of the UCLA network [abstract 193]. Proc Am Soc Clin Oncol 2001; 20: 49a

    Google Scholar 

  28. Carey LA, Dees EC, Sawyer L, et al. Cardiotoxicity of trastuzumab (Herceptin, H) given weekly with taxol (T) immediately following 4AC as initial therapy for primary breast cancer (BrCa) [abstract 253]. Proc Am Soc Clin Oncol 2002; 21: 64a

    Google Scholar 

  29. Fisher B, Costantino JP, Redmond CK, et al. Endometrial cancer in tamoxifentreated breast cancer patients: findings from the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-14. J Natl Cancer Inst 1994; 86: 527–37

    Article  CAS  PubMed  Google Scholar 

  30. Jayesimi JA, Buzdar AU, Decker DA, et al. Use of tamoxifen for breast cancer: twenty-eight years later. J Clin Oncol 1995; 13: 513–29

    Google Scholar 

  31. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 1998; 90: 1371–88

    Article  CAS  PubMed  Google Scholar 

  32. Pritchard KI. Endocrine therapy for breast cancer. Oncology 2000; 14: 483–92

    CAS  PubMed  Google Scholar 

  33. Fisher B, Dignam J, Wolmark N, et al. Tamoxifen and chemotherapy for lymph node-negative, estrogen receptor-positive breast cancer. J Natl Cancer Inst 1997; 89: 1673–82

    Article  CAS  PubMed  Google Scholar 

  34. Beatson GT. On the treatment of inoperable cases of carcinoma of the mamma: suggestions for a new method of treatment, with illustrative cases. Lancet 1896; II: 104–7

    Article  Google Scholar 

  35. Goodwin PJ, Ennis M, Pritchard KI, et al. Risk of menopause during the first year after breast cancer diagnosis. J Clin Oncol 1999; 17: 2365–70

    CAS  PubMed  Google Scholar 

  36. Kaufmann M. Zoladex™ (goserelin) vs CMF as adjuvant therapy in pre-/perime-nopausal, node-positive, early breast cancer: preliminary efficacy results from the ZEBRA study [abstract P53]: ZEBRA Trialists’ Group. Breast 2001; 10Suppl. 1: S30

    Google Scholar 

  37. Jonat W. Zoladex™ versus CMF adjuvant therapy in pre-/perimenopausal breast cancer: tolerability and amenorrhea comparisons [abstract 333]. Proc Am Soc Clin Oncol 2000; 19: 87a

    Google Scholar 

  38. Wallwiener D, Possinger K, Bondar G, et al. Leuprorelin acetate vs CMF in the adjuvant treatment of premenopausal women with ER/PR-positive, node-positive breast cancer: Interim results of the TABLE study [abstract 132]. Proc Am Soc Clin Oncol 2000; 19: 72a

    Google Scholar 

  39. Jakesz R, Hausmaninger H, Samonigg H, et al. Complete endocrine blockade with tamoxifen and goserelin is superior to CMF in the adjuvant treatment of premenopausal, lymph node-positive and negative patients with hormone-responsive breast cancer [abstract S26]. Breast 2001; 10Suppl. 1: S10

    Google Scholar 

  40. Boccardo F, Rubagotti A, Amoroso D, et al. Cyclophosphamide, methotrexate, and fluorouracil versus tamoxifen plus ovarian suppression as adjuvant treatment of estrogen receptor-positive pre-/perimenopausal breast cancer patients: results of the Italian Breast Cancer Adjuvant Study Group 02 randomized trial. J Clin Oncol 2000; 18: 2718–27

    CAS  PubMed  Google Scholar 

  41. Boccardo F, Rubagotti A, Amoroso D, et al. CMF versus tamoxifen (TAM) plus ovarian suppression (OS) as adjuvant treatment of ER-positive (ER+) pre/perimenopausal breast cancer (BCA) patients (pts) [abstract P62]. Breast 2001; 10Suppl. 1: S32

    Google Scholar 

  42. Roche HH, Kerbrat P, Bonneterre J, et al. Complete hormonal blockade versus chemotherapy in premenopausal early-stage breast cancer patients (pts) with hormone-receptor (HR+) and 1–3 node-positive (N+) tumor: results of the FASG 06 trial [abstract 279]. Proc Am Soc Clin Oncol 2000; 19: 72a

    Google Scholar 

  43. Davidson NE, O’Neill A, Vukov A, et al. Effect of chemohormonal therapy in premenopausal, node-positive, receptor-positive breast cancer: an Eastern Cooperative Oncology Group Phase III Intergroup Trial (E5188, INT-0101) [abstract 69]. Breast 1999; 8: 232–3

    Article  Google Scholar 

  44. Baum M, Houghton J, Odling-Smee W, et al. Adjuvant Zoladex in premenopausal patients with early breast cancer: results from the ZIPP trial [abstract P64]. Breast 2001; 10Suppl. 1: S32–3

    Google Scholar 

  45. Muss HB. Role of adjuvant endocrine therapy in early-stage breast cancer. Semin Oncol 2001; 28: 313–21

    Article  CAS  PubMed  Google Scholar 

  46. Goldhirsch A, Glick JH, Gelber RD, et al. Meeting highlights: International Consensus Panel on the Treatment of Primary Breast Cancer. J Clin Oncol 2001; 19: 3817–27

    CAS  PubMed  Google Scholar 

  47. National Institutes of Health Concensus Development Panel. National Institutes of Health Consensus Development Conference Statement: adjuvant therapy for breast cancer; 2000 Nov 1–3. J Natl Cancer Inst 2001; 93: 979–89

    Article  Google Scholar 

  48. Gelber RD, Bonetti M, Goldhirsch A. Tailoring treatments for the individual patient [abstract]. Breast 2003; 12Suppl. 1: S15

    Article  Google Scholar 

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Acknowledgments

This review was supported by an unrestricted educational grant from AstraZeneca. The author has no conflicts of interest that are directly relevant to the content of this manuscript.

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  1. Klinik für Gynäkologie und Geburtshilfe, Universitäts-Klinikum, Michaelisstr. 16, Kiel, 24105, Germany

    Walter Jonat

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Jonat, W. Adjuvant Therapy for Early Breast Cancer in Pre-/Perimenopausal Women. Am J Cancer 2, 227–235 (2003). https://doi.org/10.2165/00024669-200302040-00001

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