According to results recently presented at the 2006 annual San Antonio Breast Cancer Symposium, additional adjuvant chemotherapy may improve the survival of patients with Stage IIIB breast cancer who do not have a complete disappearance of detectable cancer following neoadjuvant chemotherapy.
Stage IIIB breast cancer refers to cancer that has spread to tissues near the breast, such as the skin or chest wall, and that may also have spread to lymph nodes within the breast or under the arm.
Standard treatment for Stage IIIB breast cancer may include neoadjuvant chemotherapy followed by surgery, radiation therapy, adjuvant chemotherapy, and hormone therapy if indicated. Neoadjuvant chemotherapy refers to chemotherapy given before surgery. Adjuvant chemotherapy refers to chemotherapy given after surgery.
Patients who experience a complete disappearance of detectable cancer (pathological complete response) after neoadjuvant chemotherapy have better survival than patients who still have evidence of cancer after neoadjuvant chemotherapy. Researchers therefore continue to evaluate ways to improve the survival of patients who do not have a complete response to neoadjuvant chemotherapy.
Researchers from Italy recently conducted a trial to evaluate the effects of additional adjuvant chemotherapy among patients with Stage IIIB breast cancer who do not have a pathological complete response to neoadjuvant chemotherapy.
This trial included 48 patients who were all initially treated with the chemotherapy drugs Platinol® (cisplatin), Ellence® (epirubicin), and Navelbine® (vinorelbine). Subsequent treatment included surgery, radiation therapy, adjuvant chemotherapy with Cytoxan® (cyclophosphamide), methotrexate, and 5-fluorouracil, and hormone therapy.
In addition to these treatments, some patients who did not have a complete response to neoadjuvant chemotherapy were given additional adjuvant chemotherapy with Ellence followed by Taxotere® (docetaxel).
Half the study participants have now been followed for more than six years.
- Cancer-free survival was 92% among patients who had a complete response to neoadjuvant chemotherapy. Among patients who did not have a complete response to neoadjuvant chemotherapy, cancer-free survival was 100% among patients who received additional adjuvant chemotherapy and 53% among patients who did not receive additional adjuvant chemotherapy.
The researchers concluded that, although this trial was small, it appears that additional adjuvant chemotherapy may provide a significant survival benefit to patients with Stage IIIB breast cancer who do not experience complete disappearance of detectable cancer following neoadjuvant chemotherapy. Future studies that include different chemotherapy regimens will help to determine the true clinical effectiveness of this treatment approach.
Reference: Ionta MT, Atzori F, Scanu A et al. Induction and reinduction chemotherapy following standard treatment in Stage IIIB breast cancer patients achieving less than pCR (<pCR) after primary chemotherapy: results from a pilot Italian study (ICARO 1). Proceedings from the 2006 San Antonio Breast Cancer Symposium. Abstract #3096.