Breast Cancer

WASHINGTON-A consensus conference convened to assess the treatment of estrogen deficiency symptoms in breast cancer survivors has recommended that physicians treat these women with “tailored treatment strategies” that avoid the use of estrogen but provide its short-term and long-term benefits.

SOUTHAMPTON, Bermuda-Shortly after the publication of trial results showing similar efficacy of antiestrogens toremifene (Fareston) and tamoxifen (Nolvadex) in metastatic breast cancer, the Finnish Breast Cancer Group started to plan a comparison study of the two agents as adjuvant breast cancer therapy, said Kaija Holli, MD, of Tampere University Central Hospital, Tampere, Finland.

HAMBURG-“I can see at least three new directions that carry the potential for significant improvements in the care of breast cancer patients in the coming years,” said Dr. Martine Piccart, winner of the 1997 Hamilton Fairley Award of the European Society of Medical Oncology (ESMO) in her address at the Ninth European Cancer Conference (ECCO 9).

Endocrine therapy has long been a mainstay in the therapy of metastatic breast cancer and in the adjuvant setting. The introduction of anastrozole (Arimidex) to the market in 1996 has provided another option for such treatment. Drs. Goss and Tye provide a thorough review of anastrozole and outline its advantages over other aromatase inhibitors as adjuvant therapy for breast cancer and its potential use in the treatment of early breast cancer. The authors delineate many important issues regarding the use of anastrozole; an understanding of these issues is imperative for the optimal utilization of this therapy. The paper has two shortcomings: (1) It focuses almost solely on aromatase inhibitors, to the neglect of other endocrine therapies. (2) Many references are unconventional and represent data on file with various drug manufacturers, which are not easily accessible to readers.

Anthracycline antibiotic use is limited by cardiac toxicity. The risk factors are cumulative dose, radiation to the chest and mediastinum, age, and preexisting myocardial impairment. Dexrazoxane (Zinecard) can prevent

Aromatase (estrogen synthetase) is the enzyme complex responsible for the final step in estrogen synthesis-the conversion of androstenedione and testosterone to estrone and estradiol, respectively. Inhibitors of this enzyme

HAMBURG-In previously un-treated women with advanced breast cancer, doxorubicin (Adriamycin) yields a higher response rate and longer progression-free survival than does paclitaxel (Taxol), according to the results of a randomized crossover trial conducted by the EORTC and presented at the Ninth European Cancer Conference (ECCO 9).

Data from North American clinical trials have shown that vinorelbine (Navelbine) is well tolerated when used as a single agent for the treatment of non-small-cell lung cancer, advanced breast cancer, or ovarian cancer. Myelosuppression is the primary dose-limiting toxicity.

SOUTHAMPTON PRINCESS, Bermuda-Three large randomized studies comparing the antiestrogens toremifene (Fareston) and tamoxifen (Nolvadex) in patients with advanced breast cancer showed no significant differences in efficacy or toxicity, Richard A. Gams, MD, of the James Cancer Hospital, Ohio State University, said at a symposium on antiestrogen therapy for breast cancer sponsored by Schering.

Women being treated postsurgically with tamoxifen (Nolvadex) to prevent breast cancer recurrence may also gain some

ATLANTA-With 8 million new breast cancer patients each year worldwide, “we’re looking at a tremendous number of individuals being followed for recurrence,” Hyman B. Muss, MD, of Fletcher Allen Health Care, Burlington, Vermont, said at the Perspectives in Breast Cancer symposium.

Women who choose breast reconstruction with autogenous tissue rather than an implant may experience better psychosocial

It is not often that a reviewer agrees entirely with material presented in an article. I find myself in the happy situation of largely agreeing with the basic thrust of this interesting report by Chadha and Axelrod. They begin by describing the increased incidence of breast cancer over the recent decade, but do not mention that since 1990 there has actually been a decreased incidence of breast cancer.[1] In retrospect, it has become clear that the statistical increase in breast cancer during the 1980s was an artifact of extensive mammographic screening, which caught the initial appearance of disease earlier and artificially created a temporary surge of cases that has since abated.[2]

Although the article by Senie and Tenser reviewing some of the data relevant to whether operative timing within the menstrual cycle affects breast cancer outcome is reminiscent of a recent paper that appeared in the December 1996 issue of the Journal of Women’s Health,[1] the question it considers is potentially important enough that this issue should also be raised in Oncology. The article points out the experimental basis for believing that an important interaction may occur between the host-cancer-surgery and the mammalian reproductive cycle.[2,3] This is an important supposition because clinicians have routinely assumed that no experimental foundation underlaid the first and 31 subsequent analyses of relevant clinical data[4,5]-an assumption that is false.

The authors provide a comprehensive overview of the role of axillary lymphadenectomy in the treatment of early-stage breast cancer. They do not argue against lymphadenectomy for patients with clinical T2 and 3 tumors and clinical N1 and 2 nodes. However, for clinical N0 cancers and for postmenopausal patients with hormone-receptor-positive tumors, the authors propose radiotherapy to the axilla as a modality less expensive than surgery and with fewer complications. They suggest observation only for lesions associated with a less than 10% to 15% chance of axillary metastasis (T1a cancers, tubular carcinomas, ductal carcinoma in situ [DCIS] with microinvasion). However, for patients with lesionsless than 1 cm with “high-risk features (presence of tumor emboli in vessels, poor nuclear grade, etc),” axillary lymphadenectomy “should continue to serve as a refined prognostic indicator for selection of patients for adjuvant therapy.”

The discussions and debates about the use of estrogen replacement therapy (ERT) in women with breast cancer often seem to ignore or at least leave unnoted the extensive data supporting the general premise that increased, but physiologic levels of estrogens are associated with poorer survival in postmenopausal women with breast cancer. Dr. Colditz summarizes various lines of evidence bolstering this general premise, providing us with some needed lessons about the complexities of interpreting epidemiologic studies and about human cancer biology. Particularly illuminating are his discussion of the biases in ERT-breast cancer causation studies and his exploration of the reasons for the apparently better survival in ERT users who develop breast cancer.

A number of recent studies have suggested that survival among premenopausal women after primary treatment of breast cancer may be affected by the estimated hormonal milieu at the time of surgery, especially in those with

Dr. Colditz has reviewed the potential hazards of hormone replacement therapy in breast cancer survivors. Let us presume, for the sake of brevity, that his assumptions are correct. With so many risks, why would a breast cancer survivor consider taking hormone replacement, and why would an oncologist prescribe it?

Female reproductive hormones cause breast cancer. Long-term use of postmenopausal hormones increases the risk of breast cancer. The apparent survival advantage seen in women diagnosed with breast cancer while taking

While doxorubicin (Adriamycin) is among the most active single agents in the treatment of breast cancer and other solid tumors, its concomitant toxicity limits its use. Quality-of-life issues have driven the search for gentler,

In light of the changing trends in the diagnosis and management of invasive breast cancer, the practice of routine axillary dissection should be reevaluated. A growing number of patients with breast cancer are diagnosed as

Contemporary breast cancer treatment research has focused on systemic postoperative adjuvant treatment and the elimination of established micrometastases. An alternative approach addresses the potential for seeding at the time of primary surgery. Several retrospective reports have suggested that the hormonal milieu during lumpectomy or mastectomy impacts on the likelihood of tumor cell shedding and implantation at distant sites.

The article written by Chadha and Axelrod provides a timely discussion of several critical issues in the current debate over the use of axillary lymph node dissection in early-stage breast cancer. As new information and techniques become available, they and others have reassessed the value of axillary lymph node dissection in four key areas:

Breast cancer is second only to lung cancer as a leading cause of cancer mortality in women. In women with metastatic, hence, essentially incurable disease, we strive to find effective chemotherapeutic regimens that offer a

Twenty-four patients with metastatic breast cancer that had progressed after high-dose chemotherapy with peripheral blood progenitor cell (PBPC) support were given intramuscular methotrexate in combination with oral