Treatment of metastatic breast cancer in premenopausal women using CAF with or without oophorectomy: an Eastern Cooperative Oncology Group Study.

Falkson, Geoffrey; Gelman, Rebecca; Tormey, Douglass C.; Falkson, Carla I.; Wolter, Janet; Cummings, Frank J.

doi:10.1200/jco.1987.5.6.881

Cited by 24 publications

(3 citation statements)

References 19 publications

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“…The response rate for the combined arm was 84% and 76% for FAC (p¾ 0.42) (68). These gures were recorded from the initial report also containing non-randomised 58 patients with oestrogen receptor negative cancers which were directly allocated to only FAC therapy (68).…”

Section: Oophorectomy »Chemotherapy ×S Only Chemotherapymentioning

confidence: 99%

A Systematic Overview of Chemotherapy Effects in Breast Cancer

Bergh¹,

Jönsson²,

Glimelius³

et al. 2001

Acta Oncologica

150

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A systematic review of chemotherapy trials in several tumour types was performed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures for the evaluation of the scientific literature are described separately (Acta Oncol 2001; 40: 155-65). This synthesis of the literature on chemotherapy for breast cancer is based on 233 randomised studies, 9 meta-analysis of randomised studies, a population-based cohort study and 18 overviews/retrospective analyses including a total of 155,243 patients. The conclusions reached can be summarised into the following points: Adjuvant treatment-- There is solid scientific support from randomised studies that adjuvant polychemotherapy at 10 years will result in an absolute mortality reduction for patients younger than 50 years by 12% for node positive (34% relative mortality reduction corresponding to an estimated median survival prolongation of several years) and 6% for node negative patients. For women aged 50 to 69 years, the corresponding figures for node positive and node negative patients are 6% and 2%, respectively (approximately 11% relative mortality reduction). Anthracycline-containing combinations result in an absolute survival benefit at five years of 3%, compared with non-anthracycline based polychemotherapy. There are indications that the taxane paclitaxel may further improve the survival compared with anthracyclines. However, the limited data preclude conclusions for the routine care. The addition of tamoxifen to chemotherapy further enhances the survival benefit for receptor positive subgroups. The roles of more dose-intensive regimens, including high-dose therapy with stem cell support, are presently studied in randomised investigations. The data presented so far are conflicting but they do not in general support high-dose therapy. Quality of life, based on analyses of randomised studies, demonstrate that adjuvant polychemotherapy has an initial detrimental effect, but long-term follow-up of treated patients demonstrates no impairment of quality of life compared with untreated patients. Polychemotherapy in standard doses should be offered to premenopausal node positive patients, and the corresponding postmenopausal group with a receptor-negative breast cancer and to node negative patients with high risk factors. Polychemotherapy should be combined with tamoxifen to all patients with receptor-positive tumours. Due to a need of more knowledge in this field, patients should be included in investigational protocols. Locally advanced breast cancer-- Based on current knowledge, treatment of patients with locally advanced breast cancer should include neoadjuvant/preoperative polychemotherapy since there is evidence from controlled studies that such therapy will statistically significantly increase the number of patients who can be offered breast-conserving surgery. Indirect comparisons also demonstrate survival improvements, but the scientific support is equivocal. Metastatic breast cancer-- The median survival for patients with metastatic disea...

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Section: Oophorectomy »Chemotherapy ×S Only Chemotherapymentioning

confidence: 99%

A Systematic Overview of Chemotherapy Effects in Breast Cancer

Bergh¹,

Jönsson²,

Glimelius³

et al. 2001

Acta Oncologica

150

View full text Add to dashboard Cite

show abstract

“…AS impressive as these results are, a study from the Eastern Cooperative Oncology Group (ECOG) that utilized conventional CAF with or without oophorectomy in premenopausal women with metastatic breast cancer reported strikingly similar results. The overall response rate was 68%, an d the complete response rate was 30% among the 50 ER-negative patients [57]. Among patients in the ECOG without bone metastases (only two patients in the Duke study had bone secondary lesions), the overall and complete response rates were 91% and 50%, respectively.…”

Section: High Dose Chemotherapymentioning

confidence: 96%

Management of metastatic breast cancer

Wong

Henderson

1994

World j. surg.

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Systemic treatment almost certainly prolongs the median survival of women with metastatic breast cancer, and it may prolong the survival of a small number of patients substantially. Even with conventional therapy, 10% or more patients may live into the second decade after recurrence. However, the disease cannot be eradicated, and the primary goal of treatment remains palliation and improvement of the quality of life. Because of the great variability in the pattern and course of the disease from one patient to another, therapy should be selected judiciously to maximize response and minimize toxicity. In some clinical situations, such as pathologic fractures and brain metastases, local therapies alone, such as surgery or irradiation, are the treatments of choice. Patients who will respond to endocrine therapy are well defined, and all patients with the characteristics of an endocrine responder deserve a chance at palliation with this modality alone because of its limited toxicity. A number of new forms of endocrine therapy with more specific targets at estrogen and progesterone receptor sites are now in clinical trials. When used appropriately, chemotherapy significantly improves patient quality of life despite its toxicity. No drug combinations, schedules, or doses have been shown to prolong survival or provide better net palliation than classic CMF (oral cyclophosphamide with intravenous methotrexate and 5-fluorouracil) or CAF (intravenous cyclophosphamide, doxorubicin, and 5-fluorouracil). Treatment with these combinations in excess of 6 to 9 months provides only marginal additional benefits and no survival advantage. The role of high dose chemotherapy with autologous bone marrow transplantation remains a promising area of investigation, but the available survival data are entirely compatible with the possibility that this modality will eventually prove inferior to conventional therapy. Many new cytotoxic agents with unique mechanisms of action are currently under investigation, including taxol, taxotere, Topotecan, and amonafide. Taxol may be the most promising therapy now available for patients whose disease has become refractory to doxorubicin. Biologic therapies using monoclonal antibodies against a specific oncogene or its product have entered clinical trials, and novel drug delivery systems using liposomes are under evaluation.

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“…Cyclophosphamide, Adriamycin, and 5-fluorouracil (CAF) with and without oophorectomy were compared by Falkson et al [36], in a trial of 131 premenopausal women with metastatic breast cancer that was ER positive (n = 29), ER negative (n = 50) or where the receptor status was unknown (n = 52). The ER-positive and the ER-unknown patients were randomized to receive either CAF alone (n = 38) or oophorectomy followed by CAF (O-CAF; n = 43).…”

Section: Chemotherapy With or Without Oophorectomy In Metastatic Breamentioning

confidence: 99%

Ovarian Suppression in the Management of Premenopausal Breast Cancer: Methods and Efficacy in Adjuvant and Metastatic Settings

et al. 2008

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Ovarian suppression has been used to treat hormone-responsive metastatic breast cancer in premenopausal women for over 100 years and is currently under continued evaluation for treatment in the adjuvant setting. In this article, ovarian suppression by surgery, radiation, and pharmacological therapy is discussed, including the risks, benefits, and efficacy of each strategy. The role of ovarian suppression in premenopausal women with early and advanced stages of breast cancer will be reviewed. It is hoped that this review will assist clinicians and their patients in selecting the appropriate therapy if ovarian suppression is indicated.

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Treatment of metastatic breast cancer in premenopausal women using CAF with or without oophorectomy: an Eastern Cooperative Oncology Group Study.

Cited by 24 publications

References 19 publications

A Systematic Overview of Chemotherapy Effects in Breast Cancer

A Systematic Overview of Chemotherapy Effects in Breast Cancer

Management of metastatic breast cancer

Ovarian Suppression in the Management of Premenopausal Breast Cancer: Methods and Efficacy in Adjuvant and Metastatic Settings

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