Adjuvant therapy of breast cancer with or without additional treatment with alternate drugs

Abstract

Three hundred ten patients with Stage II or Stage III breast cancer were entered on an adjuvant protocol consisting of a combination of 5-fluorouracil, doxorubicin, cyclophosphamide, vincristine, and prednisone (FACVP). In the second phase of the study, patients with estrogen receptor-negative tumors received sequential courses of methotrexate and vinblastine. Other patients, who were estrogen receptor-positive or unknown, were randomized to receive either tamoxifen alone or tamoxifen plus methotrexate and vinblastine. All therapy was completed within 1 year. The estimated disease-free rate at 5 years was 68% among patients with Stage II disease and 52% for patients who had Stage III disease. Among patients with estrogen receptor-positive tumors, disease-free survival was significantly prolonged in patients who received methotrexate and vinblastine in addition to tamoxifen (P = 0.04). However, this difference was less pronounced when all randomized patients (including those whose estrogen receptor status was unknown) were included in the comparison. Although most patients experienced moderate to severe granulocytopenia, infectious complications were infrequent. One patient died of septicemia. Congestive heart failure developed in two patients, one of whom had a history of myocardial infarction and congestive heart failure.

Monitoring the therapeutic response of locally advanced breast cancer patients: Sequential in vivo proton MR spectroscopy study

“…Patients who showed a strong positive response with tumor regression (from inoperable to operable size) and were scheduled for surgery were evaluated two weeks after the third cycle of chemotherapy, while patients who showed a slow response or no response received another three cycles of NACT and were evaluated thereafter. 1 H MRS data from normal breast tissues of healthy volunteers (controls, N ϭ 28) were used to compare the data obtained from the LABC patients. Only patients with LABC (i.e., TNM stages IIA, IIIA, IIIB, and IV) were included in this study.…”

Less efficacy with alternating regimen as adjuvant chemotherapy in stage II node-positive breast cancer: results at 8 years (Pronacam 85)

“…This assumption was based on a mathematical model as well as on experimental and early clinical observations regarding advanced Hodgkin's disease and small-cell lung cancer (Evans et al, 1987). Our results in patients with one to three positive axillary nodes suggest that six full cycles of CMF in premenopausal or FEC in post-menopausal women are superior to the administration of CMF/EC regimen for both DFS (Spittle et al, 1987;Budzar et al, 1988;Falkson et al, 1991;Bonadonna et al, 1995). Conversely, results from the ECOG (Tormey et al, 1992) showed prolonged DFS in patients receiving alternating chemohormonotherapy in the adjuvant setting, although the use of hormonal manipulation obscures the interpretation of data.…”

Magnetic resonance imaging of breast cancer: Clinical indications and breast MRI reporting system

“…Thus, the overall goal of treatment in this setting is to provide local control and improve overall survival. Today, most patients with locally advanced breast cancer receive neoadjuvant chemotherapy followed by mastectomy, axillary node dissection, and radiation therapy, followed by consolidation chemotherapy depending on tumor response (79–81). Response to neoadjuvant chemotherapy is rated on breast physical examination, and is usually classified as no response (NR), partial response (PR), or complete response (CR) based upon residual tumor on palpation.…”

“…Investigators reported that preoperative neoadjuvant chemotherapy, along with systemic therapy after local treatment by surgery and radiation, improved disease‐free and overall survival (79–81). Preoperative neoadjuvant chemotherapy is defined as combined chemotherapy given to breast cancer patients who have large tumor masses (stage T3 or T4) and/or regional lymph node involvement prior to definitive surgical treatment for local control.…”