Adjuvant Systemic Therapy: The Issues of Timing and Sequence
Adjuvant systemic therapy in breast cancer has been widely used during the last three decades and has been shown to reduce relapses and mortality (Early Breast Cancer Trialist’s Collaborative Group 1992). The rationale for its introduction was that adjuvant treatment may kill tumor cells released into the circulation at the time of primary surgery. Subsequent hypotheses ascribe the high risk for systemic relapse to micrometastases already present at the time of breast cancer diagnosis. Although the interval from breast cancer diagnosis to postoperative adjuvant therapy is short compared to the presumed preclinical duration of tumor growth, it appears that early chemotherapy onset may be advantageous in terms of tumor cell kill and that a delay in starting adjuvant treatments may result in increased resistance to cytotoxics (Goldie and Coldman 1979).
KeywordsBreast Cancer Adjuvant Systemic Therapy Primary Chemotherapy Early Breast Cancer Trialist International Breast Cancer Study Group
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- Early Breast Cancer Trialists’ Collaborative Group (1992) Systemic treatment of early breast cancer by hormonal, cytotoxic or immune therapy: 133 randomised trials involving 31000 recurrences and 24000 deaths among 75000 women. Lancet 339: pp 1–5 and pp 71–85Google Scholar
- Fisher B, Wickerham DL (1991) Preoperative systemic therapy for the treatment of primary breast cancer. In: Powles TJ, Smith IE (eds) Medical management of breast cancer. Dunitz, London, pp 281–286Google Scholar
- Forrest APM, Levack PA, Chetty U (1986) A human tumour model. Lancet i:840–842Google Scholar
- Goldhirsch A, Gelber RD, Castiglione M, Price KN, Rudenstam C-M, Lindtner J, Collins J, Senn H-J, Brunner KW, Galligioni E, Cavalli F, Gudgeon A, CortesFunes H, Tattersall M, Marini G, Byrne M, Snyder R, Forbes J, Hürny C, Coates A (1994) For the international Breast Cancer Study Group. Present and future projects of the International Breast Cancer Study Group. Cancer 74: 1139–1149Google Scholar
- Goldhirsch A, Gelber RD, Price KN, Castiglione-Gertsch M, Coates AS, Rudenstam CM, Collins J, Lindtner J, Hacking A, Marini G, Byrne M, Cortés-Funes H, Schnürch G, Brunner KW, Tattersall MHN, Forbes J, Senn HJ (1994) Effect of systemic adjuvant treatment on first sites of breast cancer relapse. Lancet 343: 377–381PubMedCrossRefGoogle Scholar
- Jones AL, Smith IE, O’Brien MER, Talbot D, Walsh G, Ramage F, Robertshaw H, Ashley S (1994) Phase II study of continuous infusion fluorouracil with epirubicin and cisplatin in patients with metastatic and locally advanced breast cancer: an active new regimen. J Clin Oncol 12 (6): 1259–1265PubMedGoogle Scholar