Panel Discussion: Perioperative Chemotherapy for Breast Cancer

Abstract

Moderated by K. W. Brunner (Bern), the second panel discussion dealt with perioperative chemotherapy in breast cancer. Preoperative chemotherapy as presented extensively by the Hellenic Breast Cooperative Group may have some potential for advanced stage III disease and there are certainly some interesting aspects (chemosensitivity testing in vivo, tumor shrinkage, immunostimulation?) to this approach, but it has clearly been felt that this type of chemotherapy so far has no proven clinical evidence of advantage in less advanced disease where preoperative chemotherapy might preclude some patients from potentially curative surgery. This is in contrast to osteosarcoma (see below) and many childhood solid tumors, and is possibly due to factors such as chemosensitivity and tumor growth. True perioperative chemotherapy, as reported by R. Nissen-Meyer and the Scandinavian Adjuvant Chemotherapy Study Group, resulted in a significantly prolonged relapse-free survival. Interestingly, the benefit was found both in stage I and in stage II, and in premenopausal as well as in postmenopausal patients. Compared with many other adjuvant trials showing widely differing degrees of benefit among the patient subgroups, the results in the first Scandinavian study uniformly support immediate postoperative chemotherapy, possibly indicating a different mechanism of action. More interestingly, preliminary analysis of the second study shows the old single-drug cyclophosphamide therapy to be at least as effective as the conventionally timed CMF multidrug regimen.