Combined chemo- and hormonal therapy in advanced breast cancer

Abstract

In a randomized study sf 213 evaluable patients, a combination of hormone and polychemotherapy was compared with polychemotherapy alone. Three types of hormonal treatment were employed. The choice was dependent upon menopausal status or previous hormonal therapy. Forty-two pre-menopausal women were treated either with oophorectomy plus a modified five-drug "Cooper" combination or with the chemotherapy regimen alone. Oral methotrexate, cyclophosphamide and prednisone for two weeks was alternated with two-week courses of I.V. fluorouracil, vincristine, and oral prednisone. Nineteen patients treated with the combined modality demonstrated a CR + PR in 74%, a minor PR in 16%, and NC + P in 10%. The respective rates in 23 premenopausal women receiving chemotherapy only were 43%, 22%, and 35%. Median time to progression was 9.5 months and median survival was 19.9 months in the combined group vs 7.8 months and 13.2 months, respectively, in the "chemotherapy only" group. Forty-eight post-menopausal patients without previous hormonal therapy were treated with diethylstilbestrol and the same cytostatic therapy as described; 48 patients received chemotherapy alone.CR + PR in the combined group is 63%, minor PR 21%, NC + P 16%, median remission duration 8.4 months, median survival 26.7 months. The corresponding results in the "chemotherapy only" group are 5496, 25%, and 21%, with 10.6 months median remission duration and 19.2 mooths median survival. Seventy-five post-menopausal patients with previous hormonal therapy, mainly oophorectomy (53 patients), received either chemotherapy plus a progesterone (38 patients) or cytostatic drugs only (37 patients). Results in the combined group are: CR + PR 53%, minor PR 2496, NC + P 23%; median remission duration 8.9 months, median survival 18.1 months; in the "chemotherapy only" group the corresponding figures are: 63%, ll%, 27%; 10.0 months, 22.8 months. These results are further analyzed according to dominant metastatic site, age groups, and intervals from diagnosis to the beginning of protocol therapy.

Pamidronate prevents skeletal complications and is effective palliative treatment in women with breast carcinoma and osteolytic bone metastases

“…Response rates for the treatment of bone metastases with hormonal therapy or chemotherapy generally have been lower than overall tumor response rates. Randomized studies have shown objective radiologic response rates in bone varying widely from 0–58% for either chemotherapy11, 12 or combined hormonal and chemotherapy13, 14 regimens. Bone pain may be relieved with antineoplastic treatment, usually more so with hormonal treatment than with chemotherapy.…”

The tumour response of postmenopausal hormone receptor-positive breast cancers undergoing different types of neoadjuvant therapy: a meta-analysis

“…Although there have been a large number of studies concluding the increased clinical response rate of tumours in the combined strategy of chemotherapy and endocrinotherapy compared to chemotherapy alone to treat advanced HRpositive breast tumours [48][49][50], there are a paucity of clinical trials comparing the clinical utility of the combination to endocrinotherapy or chemotherapy in a neoadjuvant setting. Of these, most indicate no differences of pCR rate and ORR between postmenopausal HR-positive breast cancer women who undergo NCET and monotherapy of NET or NCT, which is consistent with our results.…”

Chemoimmunotherapy with or without oophorectomy in premenopausal patients with advanced breast cancer

“…The response rate observed with any of the three treatment modalities is very similar to that obtained by other investigators employing Adriamycin-containing regimens . Furthermore, although patients in each of the three treatment groups received a variety of chemoinimunotherapy protocols, we have previously demonstrated that there is no significant difference in the response rate, duration of response, and survival in our patients treated with these various programs [20-231. In a randomized study conducted by the Swiss group for clinical cancer research (SAKK) for premenopausal patients treated with either chemotherapy alone or simultaneous oopliorectomy-chemotherapy [3] , and improved median duration of remission of 9.5 months was. observed for the simultaneous group as opposed to 7.8 months for those treated with chemotherapy alone.…”

“…No specific selection criteria were used as to the type of treatment given to each individual patient, and the choice depended upon the bias of staff physician to whom the patient was referred. The chemotherapy employed consisted of 5-FU 500 mg/m2 IV on days 1 and 8, Adriamycin 50 mg/m2 IV on day 1, and Cytoxan 500 mg/m2 on day 1 (FAC), and the cycle was repeated every 21 days; except for 15 patients who received ftorafur at 2 gm/m2 days [1][2][3][4][5] in place of 5-FU. The immunotherapy consisted of either BCG (6 X 10' organisms) by scarification of extremities 011 days 9 , 13, and 17 of every 21-day cycle or levamisole 100 mg/m2 orally twice weekly, or a combination of both.…”