The study reviewed here shows that chemotherapy after surgery significantly reduces the risk of breast cancer coming back and increases survival in women diagnosed with hormone-receptor-negative breast cancer.
Compared to hormone-receptor-positive breast cancer, hormone-receptor-negative disease tends to be more aggressive and is more likely to come back (recur). In this study, women younger than 50 when diagnosed with hormone-receptor-negative breast cancer had a 45% risk of recurrence in 10 years if they didn't receive chemotherapy. Their risk of recurrence dropped to 33% if they had chemotherapy.
When post-menopausal women are diagnosed with hormone-receptor-positive breast cancer, both chemotherapy and hormonal therapy often are used to reduce the risk of recurrence. But hormonal therapy doesn't work against hormone-receptor-negative disease.
This study looked at women who got chemotherapy in the 1970s and 1980s. Since that time, advances in the types of chemotherapy medicines available and the way they are used make it likely that the benefits of chemotherapy are even better today.
Getting the best breast cancer treatment can feel like a balancing act: you want to do as much as you can to get rid of the cancer and lower the risk of it coming back. But you'd like to avoid uncomfortable side effects that might lower your quality of life. Together, you and your doctor will consider your specific situation and decide on the treatment plan that is best for YOU.
NEW YORK (Reuters Health) - A review of published clinical trials indicates that adjuvant chemotherapy regimens - drug therapy administered after surgical removal of the cancer -- used in the 1970s and 1980s safely improved the long-term survival of women with breast cancers associated with poor outcomes.
The authors of the report, published in The Lancet, believe that current and future chemotherapy regimens are likely to yield even greater improvements in survival for women with estrogen-negative breast cancer. This type of breast tumor does not respond to treatment as well as estrogen-positive tumors do.
"This latest update from the Early Breast Cancer Trialists' Collaborative Group further confirms the contribution of chemotherapy to the decreasing recurrence of estrogen receptor-negative breast cancer," Dr. Rinat Yerushalmi and Dr. Karen Gelmon, from the British Columbia Cancer Agency in Vancouver, comment in a related editorial
Dr. Richard Peto, from the University of Oxford in the UK, and colleagues analyzed data on roughly 6,000 women with estrogen receptor-poor breast cancer enrolled in 46 trials comparing adjuvant chemotherapy with no chemotherapy and from about 14,000 women enrolled in 50 trials comparing tamoxifen with no tamoxifen.
The chemotherapy regimens were used in trials starting between 1975 and 1996, were not based on taxane and typically involved six cycles. Taxanes are a class of drugs found to be very effective for breast cancer, but drugs in this class were not approved for use by the United States FDA until the 1990s. In the tamoxifen trials, which started between 1972 and 1993, the drug was given with or without chemotherapy depending on the study.
Treatment with chemotherapy was associated with significant reductions in breast cancer recurrence and mortality in women younger than 70 years of age at trial entry. For instance, in women younger than 50 years, the 10-year risks of recurrence with and without chemotherapy were 33 percent and 45 percent, a significant difference. The corresponding breast cancer mortality rates were 24 percent and 32 percent.
The chemotherapy regimens were also deemed safe, as no increase in all-cause mortality was seen with their use.
Tamoxifen, by contrast, had little effect on breast cancer recurrence or mortality in women with estrogen receptor-poor disease. Moreover, no significant interaction was noted between tamoxifen and chemotherapy.
"Efforts should now be directed towards the establishment of finer definitions of subtypes of (estrogen-receptor negative) breast cancers, the study of less debilitating but active regimens and the development of new strategies for those who are not cured by conventional chemotherapy," Yerushalmi and Gelmon conclude.
SOURCE: The Lancet, January 5, 2007
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