Abstract
After standard-dose chemotherapy (SDC), more than 50% of patients with HRPBC (defined as extensive axillary node involvement or inflammatory disease) experience relapse. Controversy has surrounded the use of HDC for HRPBC for over a decade. Current results from at least 15 randomized trials comparing diverse forms of HDC and SDC for HRPBC appear contradictory at this point [1]. In addition, some studies suggest that younger women might benefit selectively from HDC. An NCI-sponsored meta-analysis is in progress. Regardless of this unsettled issue, it is clear that a substantial percentage of HRPBC patients still relapse after HDC. Extensive prognostic studies are required to improve their outcome. Such investigations may allow us to identify adequate patient subsets and new therapeutic targets for trials of developmental therapeutics. Combinations of HDC, capable of ample cytoreduction, with novel agents that target specific tumor features responsible for post-transplant relapse may hold promise.
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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