| Postmenopausal
breast cancer patients with estrogen-sensitive tumors may not benefit
from post-surgical chemotherapy Postmenopausal breast cancer patients with estrogen-sensitive tumors who undergo post-surgical chemotherapy do not appear to benefit from it, according to an article in the July 17th issue of the Journal of the National Cancer Institute (USA). However, the research did indicate that patients with estrogen receptor-negative tumors who had chemotherapy were significantly less likely to relapse and more likely to survive five years than comparable patients who did not receive chemotherapy. The findings question the value of post-surgical chemotherapy in postmenopausal women who have node-negative disease and estrogen receptor-positive tumors. The results, said Richard Gelber, Ph.D., who headed the statistical analysis of trial data, indicate that cancer treatments need to be more finely "tailored" to the characteristics of individual patients and their tumors, in order to avoid unnecessary discomfort and expense. "I'm hoping it will cause physicians and research investigators to examine more carefully whether or not these postmenopausal women with node-negative, estrogen receptor-positive diseases should routinely be offered chemotherapy," Gelber said. A total of 1,669 patients were recruited into the international trial. All were postmenopausal and had node-negative cancer. About 75 percent had estrogen receptor-positive tumors, 23 percent had receptor-negative tumors, and about 2 percent had indeterminate receptor status. The women were randomly assigned to receive either chemotherapy followed by tamoxifen, or tamoxifen alone for five years. Analysis showed that women with estrogen receptor-negative tumors who received chemotherapy had a 15 percent increase in disease-free survival at five years (84 percent versus 69 percent) compared with patients who did not have chemotherapy. Overall five-year survival was 89 percent in the chemotherapy group compared with 81 percent in the tamoxifen-only group. But among women with estrogen receptor-positive tumors, addition of chemotherapy provided no survival benefit. Five-year disease-free survival rate was 85 percent without chemotherapy and 84 percent with it; overall five-year survival rate was 95 percent and 93 percent, respectively. The issue of routinely prescribing chemotherapy for postmenopausal, lymph node-negative patients has long been controversial. Although other studies have looked at certain aspects of the value of chemotherapy in this patient population, the current study is the first large-scale trial to compare the outcomes of chemotherapy in both receptor-negative and receptor-positive women who were also prescribed tamoxifen. The study found that patients who underwent chemotherapy felt worse during treatment and in some cases lost their hair, but that these and other quality-of-life symptoms largely disappeared afterward. "This means that they felt different during chemotherapy and it should not be used frivolously," said Gelber. "But on the other hand, this transient reduction in the quality of life should not be used as an excuse to deny chemotherapy when it can be helpful." In an editorial accompanying the report, Drs.
Antonio C. Wolff and Martin D. Abeloff said the study "clearly
confirms the survival benefit" from a short course of chemotherapy
in older women with lymph node-negative, estrogen receptor-negative
breast cancer. And it "reinforces the cautionary tone that
already permeates the clinical practice guidelines" for chemotherapy
used in similar patients but with receptor-positive disease. |