Chemotherapy For Operable Breast Cancer Research Articles

A randomised trial of adjuvant versus neoadjuvant endocrine chemotherapy of operable breast cancer

A randomised trial of adjuvant versus neoadjuvant endocrine chemotherapy of operable breast cancer

Preoperative chemotherapy of operable breast cancer (stage IIIA). Prognostic factors of distant recurrence

Preoperative chemotherapy of operable breast cancer (stage IIIA). Prognostic factors of distant recurrence

Primary medical (neo-adjuvant) chemotherapy for operable breast cancer

84 patients with large operable breast cancer have been treated with primary medical chemotherapy rather than mastectomy in three sequential studies. 86% had tumours greater than 4 cm in diameter; median diameter was 6 cm (range 1–12). Median age was 46 years (range 23–66). In the first two studies 64 patients were treated with either CMF [cyclophosphamide 100 mg orally days 1–14, methotrexate 50 mg intravenously (i.v.) days 1 and 8, and 5-fluorouracil 1 g i.v. days 1 and 8, repeating at 28-day intervals for six courses] or MMM (mitozantrone 8 mg/m 2 i.v. once every 3 weeks, methotrexate 50 mg i.v. once every 3 weeks, mytomycin C 8 mg/m 2 once every 6 weeks, for 8 courses). 69% achieved an overall response including 17% complete remissions. 27% have had local relapse but only 3% uncontrolled local relapse. Only 14% have required mastectomy. In the third study which is ongoing, 19 patients have been treated with infusional FEC (5-fluorouracil 200 mg/m 2 i.v. 24 hourly by continuous infusion via a Hickman line for 6 months, epirubicin 50 mg/m 2 i.v. bolus once every 3 weeks for 6 months, cisplatin 60 mg/m 2 i.v. once every 3 weeks for 6 months with appropriate intravenous hydration). Overall response rate so far is 84% with 58% complete remissions. There have been no local relapses and no patient has required mastectomy. This study demonstrates that primary medical chemotherapy can be used to avoid mastectomy in the great majority of patients presenting with large operable primary breast cancer. Infusional FEC may be more active than conventional chemotherapy in terms of overall response and complete remission rate, and infusional FEC chemotherapy now needs to be compared with conventional chemotherapy. The concept of primary medical therapy should also be compared with conventional mastectomy followed by adjuvant chemotherapy.

Primary medical (neoadjuvant) chemotherapy for operable breast cancer: Building on early promise

Primary medical (neoadjuvant) chemotherapy for operable breast cancer: Building on early promise

Flow cytometric detection of P-glycoprotein (P-G) in sequential fine needle aspirates (FNA) from patients receiving primary chemotherapy for operable breast cancer

Flow cytometric detection of P-glycoprotein (P-G) in sequential fine needle aspirates (FNA) from patients receiving primary chemotherapy for operable breast cancer

Neoadjuvant chemotherapy in operable breast cancer

Primary chemotherapy in localised breast cancer may prevent tumour spread during surgical treatment and reduce proliferation of micrometastases. A randomised clinical trial, in 196 premenopausal and postmenopausal patients with operable (T2-3, N0-1b) breast cancer, was started in November 1983 at the Institut Curie to compare neoadjuvant and adjuvant regimens of chemotherapy with radiotherapy with or without surgery. The patients have been followed up for 35-70 months (median 54). A neoadjuvant group received two monthly cycles of intravenous doxorubicin/cyclophosphamide/5-fluorouracil before locoregional therapy and four cycles subsequently. Six monthly cycles following locoregional therapy were administered to the adjuvant group. Because of inclusion of postmenopausal and/or node-negative patients, compliance was less than optimal in 39 patients who were analysed separately according to actual dose received. Tumour response, evaluated after two cycles of neoadjuvant chemotherapy, was significantly associated with dose (P = 0.003). Survival showed a slight non-significant advantage for the neoadjuvant group. Survival plotted by actual dose was also similar. Neoadjuvant chemotherapy was safe and at least as effective as the adjuvant regimen. Patients have been accrued to a subsequent larger trial of chemotherapy as first-line treatment.

Two simple indexes used to evaluate the impact of therapy on the quality of life of patients receiving primary chemotherapy for operable breast cancer

The psychometric characteristics of two indexes used to evaluate the subjective morbidity of chemotherapy regimens were analyzed. Both indexes assessed the duration of discomfort as perceived by the patient throughout therapy. The first index asked patients to state the number of days spent with 'discomfort', and the second index asked them which days they would like to eliminate altogether because of the unbearable symptoms experienced on those days. While the first index gives some idea of the duration of suffering, without defining it, the second highlights a specific time when the quality of her life was unacceptable to the patient. We studied these indexes in the form of a questionnaire completed by 168 women who had entered a cancer clinical trial. This trial evaluated the efficacy of primary chemotherapy in rendering conservative surgery feasible in women with operable breast cancer, but whose tumor size was greater than 3 cm. Four different treatment regimens were used: CMF, FAC, FEC, FNC (C = cyclophosphamide, M = methotrexate, F = fluorouracil, A = adriamycin, E = epirubicin, N = mitoxantrone). Seventy-nine patients were interviewed during chemotherapy and 89 during follow-up visits. Initial assessment of the reliability, discriminant and concurrent validity of the two indexes produced satisfactory results. Finally, we analyzed the responses given by 168 patients for a total of 600 treatment cycles. The average value of 'discomfort' was 3 days, whereas the average value of days 'to be eliminated' was 1. The range of subjective morbidity (for every cycle of treatment: 'discomfort = 0-30 days; 'to be eliminated' = 0-20 days) was very broad.(ABSTRACT TRUNCATED AT 250 WORDS)

A multi-center phase I trial of chemotherapy in operable breast cancer: M. Levine, K. Pritchard for the Ontario Clinical Oncology Group McMaster University, Hamilton, Ontario, Canada(23)

A multi-center phase I trial of chemotherapy in operable breast cancer: M. Levine, K. Pritchard for the Ontario Clinical Oncology Group McMaster University, Hamilton, Ontario, Canada(23)

Influence of adjuvant chemotherapy for operable breast cancer on results of treatment at relapse.

The influence of adjuvant chemotherapy (ACT) for operable breast cancer on the results of systemic therapy at relapse was retrospectively studied in 62 patients with recurrent disease. 32 had been treated with ACT [ACT (+) group] and the others had not [ACT (-) group]. The response rate (CR + PR) to the first treatment was 22% in the ACT (+) group and 43% in ACT (-) group. It is suggested that relapsing patients with a history of ACT respond poorly to the treatment as compared to those not receiving it.

Adjuvant CMF chemotherapy in operable breast cancer: ten years later.

AbstractThis article reports the 10‐year results of a trial testing radical mastectomy with or without adjuvant cyclophosphamide, methotrexate, and fluorouracil (CMF) in 386 women with breast cancer and positive axillary lymph nodes. The long‐term analysis confirmed that adjuvant chemotherapy was able to produce a significant relapse‐free survival improvement (43.4%) versus control (31.4%,p<0.001) and a trend in total survival (55.2% versus 47.3%,p=0.10). Both relapse‐free survival and total survival benefit were significant in premenopausal women. Relapsefree survival was not influenced by drug‐induced amenorrhea. In both treatment groups, the results were inversely related to the number of histologically involved axillary nodes. On relapse, salvage treatment applied in the control group failed to produce superior results compared to those achieved in the CMF group and yielded a similar median survival from first relapse between control (37 months) and CMF (32 months) patients. The incidence of severe myelosuppression and hair loss was low (less than 10%) and reversible. Prolonged chemotherapy was not associated with an increased incidence of second neoplasms. We conclude that CMF, as given in this study, was able to improve the course of premenopausal women with high‐risk breast cancer during the first decade following radical mastectomy.

Role of routine postoperative radiotherapy and nonspecific immunotherapy with BCG in combination with adjuvant chemotherapy in operable breast cancer a prospective randomized trial

Role of routine postoperative radiotherapy and nonspecific immunotherapy with BCG in combination with adjuvant chemotherapy in operable breast cancer a prospective randomized trial

The West Midlands co-operative trial of adjuvant chemotherapy for operable breast cancer

The West Midlands co-operative trial of adjuvant chemotherapy for operable breast cancer

Adjuvant chemotherapy for operable breast cancer with positive axillary nodes

Adjuvant chemotherapy for operable breast cancer with positive axillary nodes