Abstract
The role of high-dose chemotherapy in the adjuvant treatment of high-dose breast cancer has not been established. Results have been reported from six randomized studies with a symmetrical study design (Table (Table1).1). All show a lower relapse rate in the high-dose arm, but in only one study was this result statistically significant. Table 1 Randomized studies evaluating the role of high-dose chemotherapy in high-risk breast cancer Methods Patients below 56 years of age who had undergone surgery for stage II or III breast cancer were eligible if they had at least four tumor-positive axillary lymph nodes. Patients in the conventional dose (CD) arm received five courses of FEC (fluorouracil 500 mg/m2, epirubicin 90 mg/m2 and cyclophosphamide 500 mg/m2; every 3 weeks) followed by radiation therapy and tamoxifen. The high-dose (HD) arm was identical, except that high-dose chemotherapy (CTC [cyclophosphamide 6 g/m2, thiotepa 480 mg/m2 and carboplatin 1600 mg/m2]) with peripheral blood progenitor cell reinfusion was given instead of the fifth FEC course.
Highlights
Prognostic and predictive factors play important roles in profiling predicts clinical outcome of breast cancer
Genetic tests derived from gene expression profiling studies are likely to become useful as prognostic and predictive tests to guide clinical decision making in the treatment of primary breast cancer
The 76-gene profile was strongly predictive of those patients who will develop a distant metastasis within 5 years or will remain recurrence free during that period and in multivariate analysis when corrected for traditional prognostic factors including grade (HR 5.55; P < 0.00003)
Summary
Prognostic and predictive factors play important roles in profiling predicts clinical outcome of breast cancer. Results Between August 1993 and July 1999, 885 patients with primary breast cancer and four or more tumor-positive lymph nodes were randomized in 10 Dutch centers in a study of high-dose chemotherapy. We conducted a phase II trial to define the safety, the efficacy, the pathological response rate and survival associated with four cycles DXR–GMZ administered every 3 weeks followed by surgery, four cycles of FAC50 as a primary therapy in MBC. Method Fifty-four patients with invasive breast cancer treated in 2004 underwent axillary ultrasound and cytological puncture with fine needle of suspicious nodes before surgery Suspicious nodes were those with at least one of the following signs: long-to-short axis ratio less than 1.5, absence of hilius and cortical disruption. BrdU and MTT exhibited inhibition of DNA synthesis and metabolic activity of treated MBC cells compared with untreated controls
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