Intra-arterial chemotherapy for breast cancer: where to now?

Abstract

Attention is once again being focussed on the administration of chemotherapeutic agents given by the intraaterial route. The subject was first explored in the 1950s by Helman and colleagues in South Africa.’ A few other sporadic reports were published in the 1960s but although this approach was maintained for the treatment of head and neck cancers, it was only in the late 1970s and 1980s with introduction of new materials that interest in this approach for treatment of breast cancer was rekindled. Dr de Dycker’s article in this issue of The Breast reports the use of intra-arterial chemotherapy in patients with inflammatory breast cancer. 45 patients were given mitoxantrone by the intraarterial route as primary therapy and this was followed by surgery when the tumour was operable. After two courses (8 weeks of treatment) 91% of patients were suitable to undergo mastectomy. Response rate was highest in postmenopausal patients; with response to treatment being an important prognostic factor, those patients responding to the first course of treatment having the longest time to relapse and the longest overall survival. Response rates achieved by de Dycker are comparable to those obtained with high dose conventional chemotherapy but the advantage of the intra-arterial route is that side effects are much lower and responses are seen more quickly. Dr de Dycker used a super-selective angiographic approach with alternative cannulation of the internal mammary and lateral thoracic arteries with infusion of drugs over 72 h. Others’” have used implantable catheters with positioning of the outflow tip to allow infusion into the subclavian artery. These are implanted surgically and have been used in the management of both locally advanced as well as recurrent chest wall cancer. The catheter’s position can be checked by injecting a blue dye which produces staining in the area which will receive high doses of chemotherapy. This allows one to confirm that the blood flow to the tumour is intact and that the treatment is therefore likely to be effective. The side effects of this less selective approach are greater even