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).
KeywordsToxicity Estrogen Methotrexate Melphalan Tamoxifen
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