Two months of doxorubicin-cyclophosphamide with and without interval reinduction therapy compared with 6 months of cyclophosphamide, methotrexate, and fluorouracil in positive-node breast cancer patients with tamoxifen-nonresponsive tumors: results from the National Surgical Adjuvant Breast and Bowel Project B-15.

Abstract

The National Surgical Adjuvant Breast and Bowel Project (NSABP) implemented protocol B-15 to compare 2 months of Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH) and cyclophosphamide (AC) with 6 months of conventional cyclophosphamide, methotrexate, and fluorouracil (CMF) in patients with breast cancer nonresponsive to tamoxifen (TAM, T). A second aim was to determine whether AC followed in 6 months by intravenous (IV) CMF was more effective than AC without reinduction therapy. Through 3 years of follow-up, findings from 2,194 patients indicate no significant difference in disease-free survival (DFS, P = .5), distant disease-free survival (DDFS, P = .5) or survival (S, P = .8) among the three groups. Since the outcome from AC and CMF was almost identical, the issue arises concerning which regimen is more appropriate for the treatment of breast cancer patients. AC seems preferable since, following total mastectomy, AC was completed on day 63 versus day 154 for conventional CMF; patients visited health professionals three times as often for conventional CMF as for AC; women on AC received therapy on each of 4 days versus on each of 84 days for conventional CMF; and nausea-control medication was given for about 84 days to conventional CMF patients versus for about 12 days to patients on AC. The difference in the amount of alopecia between the two treatment groups was less than anticipated. While alopecia was almost universally observed following AC therapy, 71% of the CMF patients also had hair loss and, in 41%, the loss was greater than 50%. This study and NSABP B-16, which evaluates the worth of AC therapy in TAM-responsive patients, indicate the merit of 2 months of AC therapy for all positive-node breast cancer patients.

Does chemotherapy-induced neutropaenia result in a postponement of adjuvant or neoadjuvant regimens in breast cancer patients? Results of a retrospective analysis

“…This observation is in agreement with data reported in the literature showing that an ANC o1.5 Â 10 9 l À1 at the onset of chemotherapy was not convincingly associated with an increased risk of febrile neutropaenia (Greil and Jost, 2005). Previously, the National Surgical Adjuvant Breast and Bowel Project B-15 and B-16 trials showed that the reintroduction of chemotherapy with ANC ranging between 1.0 and 1.5 Â 10 9 l À1 was possible (Fisher et al, 1990a, b). In a recent retrospective study involving Hodgkin's lymphoma patients, the ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine) administration irrespective of granulocyte counts allowed the treatment to be given at full dose without delays or significant number of infective episodes (Boleti and Mead, 2007).…”

Comprehensive analysis of risk factors associating with Hepatitis B virus (HBV) reactivation in cancer patients undergoing cytotoxic chemotherapy

“…Indeed, anthracyclines have mainly been administered to patients with non-Hodgkin's lymphoma and breast cancer (Table 3). Although it is generally accepted that CHOP is an immunosuppressive regimen, only 4% of Western breast cancer patients receiving AC developed severe immunosuppression (Fisher et al, 1990). However, recent data from Chinese breast cancer patient population revealed the corresponding figure to be as high as 77% (Ma et al, 2002).…”

Triple Negative Breast Cancer - Our Experience and Review

“…There was no family history of breast cancer in any patient. Twelve patients [12] had undergone modified radical mastectomy (MRM) outside and had been referred to our hospital for further management. Five patients had metastatic disease at presentation of which three had bone metastasis (one patient had solitary vertebral metastasis and other two had multiple bony metastases), two had lung metastasis of which one had pleuritis carcinomatosis (one patient had bone metastases also), and one had liver metastases.…”

“…Apart from invasive ductal carcinoma, medullary, metaplastic, secretory, pleomorphic lobular carcinomas, adenoid cystic carcinomas etc., also belong to triple negative tumours. The main characteristics of triple negative breast cancers are they are frequent in younger women (<50 years), more frequent in AfricanAmerican women, present as interval cancers, highly chemosensitive [12,13], weak association between tumour size and lymph node metastases, more aggressive, higher chance of brain metastases, high chance of recurrence during 1 st and 3 rd year and shorter survival following first metastatic event when compared to other subtypes.…”