A recent emphasis in the treatment of cancer has been focused on individualizing therapy strategies for each patient according to differing biological characteristics of the cancer. There are two important benefits of individualized therapy: 1) the achievement of optimal treatment strategies for each patient, and 2) the sparing of some patients from unnecessary treatment. In a recent clinical study, researchers evaluated the use of chemotherapy treatment following surgery in women with rapidly growing, node-negative breast cancer.
Node-negative breast cancer means that cancer is localized within the breast and has not spread to nearby lymph nodes under the arms. Studies have indicated that the use of adjuvant chemotherapy delivered following surgical removal of the breast cancer has decreased rates of recurrence in women with localized breast cancer. However, chemotherapy may produce side effects, so recent efforts have been focused on identifying which patients are at high-risk for a recurrence. These high-risk patients may benefit from additional therapy to prevent recurrences while patients not at high-risk may be spared from additional therapy and related side effects.
Some patients with breast cancer have a specific protein, found in tissue samples taken from the cancer tumor, which has been linked to the presence of a rapidly dividing and growing cancer. In a recent clinical study, researchers evaluated the association between adjuvant chemotherapy in patients possessing this protein with the rate of cancer recurrence, in order to determine if additional treatment was beneficial. Two hundred and eighty one patients with rapidly growing, node-negative breast cancer were divided into two groups. One group of patients received 6 courses of adjuvant chemotherapy following surgery, and the other group received no additional treatment following surgery. Six and a half years following treatment, there had been 28 deaths in the group that received adjuvant chemotherapy and 47 deaths in the group that had not received adjuvant chemotherapy. Rates of recurrence were 17% for those treated with chemotherapy and 28% for those who did not receive chemotherapy. It was found that adjuvant chemotherapy was more effective in patients with more rapidly growing cancer. However, chemotherapy was more beneficial for premenopausal women than postmenopausal women.
The results of this and other clinical trials suggests that premenopausal women with node-negative breast cancer have improved outcomes as evidenced by increased disease- free survival when treated with adjuvant chemotherapy. Clinical trials have demonstrated improved disease-free survival with as few as one cycle of chemotherapy following surgery for node-negative breast cancer. Additional clinical trials are ongoing to determine the optimal number of chemotherapy cycles that are necessary to decrease the risk of cancer recurrence. In order to further reduce recurrence rates, researchers are also evaluating more intensive chemotherapy regimens and other novel treatment approaches. Women who have breast cancer may wish to talk to their doctor about the risks and benefits of adjuvant therapy or about participating in a clinical trial to better define the most effective treatment strategies for the various stages of this cancer. Two sources of information on ongoing clinical trials that can be discussed with a doctor include a comprehensive, easy to use service provided by the National Cancer Institute (
Journal of Clinical Oncology, Vol 18, No 17, pp 3125-3134, 2000)