Adjuvant therapy for breast cancer

Abstract

The use of adjuvant therapies after surgery for breast cancer has made a significant difference to breast cancer survival. The regular production of meta-analyses by the Early Breast Cancer Trials Collaborative Group has highlighted the effects of adjuvant therapies. The important histological factors that need to be considered when deciding the adjuvant therapy are tumour size, histological grade, nodal status and oestrogen receptor status. The original treatments were based on the idea that many breast cancers are hormone-sensitive and ovarian ablation was one of the first methods. The discovery of oestrogen receptors and the drug tamoxifen reduced breast cancer mortality and recurrence rates in patients with oestrogen receptor-positive tumours. Polychemotherapy regimens are very effective in pre- and post-menopausal women and are well tolerated. Anthracycline regimens are now used routinely in most pre-menopausal women (unless they have a very good prognosis). The results of ongoing trials which incorporate taxanes with chemotherapy are awaited. Another exciting potential treatment is the use of herceptin (an antibody against the HER-2 receptor) in the adjuvant setting. Postoperative radiotherapy can also be considered as an adjuvant treatment which decreases the risk of local recurrence in the breast after conservation treatment or in the chest wall after a mastectomy.