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Breast Cancer

Adjuvant Systemic Therapy for Breast Cancer

• Overview of Adjuvant Chemotherapy
• Recent Advances in Adjuvant Chemotherapy
• References

The objective of adjuvant chemotherapy and hormonal therapy (systemic therapy following surgery) in the treatment of breast cancer is the elimination of micrometastases that are believed to be present at the time of original diagnosis.¹ New administration strategies based on more refined models of tumor growth are currently being evaluated. In addition, new active agents are being incorporated into adjuvant regimens. It is hoped that investigation of new agents and strategies will result in greater reduction of occult metastatic disease.^1-3
 

Overview of Adjuvant Chemotherapy

In 1998 the Early Breast Cancer Trialists’ Collaborative Group published an overview of randomized adjuvant trials for the treatment of early breast cancer.⁴ Their analysis involved approximately 30,000 patients in 69 clinical trials. These included 47 trials of prolonged combination chemotherapy versus no chemotherapy, 11 trials of short versus prolonged use of combination chemotherapy, and 11 trials of anthracycline-containing regimens versus CMF (cyclophosphamide, methotrexate, and fluorouracil).

The overview analysis revealed that combination chemotherapy produced substantial and highly significant reductions in recurrence, both in women under 50 years of age (35% reduction) and in women ages 50 to 69 (20% reduction); few women ³ 70 years of age had been studied. Significant reductions in mortality were also observed for these age groups, 27% and 11%, respectively. After standardization for age and time since randomization, the proportional reductions in risk were similar for those patients with node-negative and node-positive disease. The age-specific benefits of therapy also appeared to be irrespective of menopausal status at presentation, estrogen-receptor status of the primary tumor, and of whether adjuvant hormonal therapy had been administered.⁴

The collaborative group also found that there appeared to be no survival advantage associated with the use of combination chemotherapy for more than 3 to 6 months. Regarding specific chemotherapy regimens, available data from randomized studies suggested that anthracycline-based regimens produced somewhat greater effects on both delaying recurrence and survival than did CMF; however, the investigators stated that it could not be determined based on available evidence whether these differences were meaningful.⁴

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