Adjuvant Chemotherapy Programs in Node-Negative Breast Cancer

  • P. Valagussa
  • R. Silvestrini
  • G. Bonadonna

Abstract

Traditionally, women with node-negative breast cancer have been regarded as having a relatively favorable prognosis following locoregional therapy (surgery and/or radiotherapy) although for more than 10 years clinical investigators have stressed that the recurrence rate in the first decade after surgery was about 25% [16, 29]. More recent evaluations of surgical series have pointed out that a group of prognostic variables, such as negative estrogen receptors (ERs), poorly differentiated tumors, evidence of high growth rate, and large tumor size are individually associated with a greater risk of relapse in women with negative nodes [18]. Recent results from prospective randomized trials carried out in Europe and in the United States have indicated that adjuvant systemic therapy has improved treatment outcome, thus making multidisciplinary treatment for this patient subset an exciting and important therapeutic approach [3, 5]. This chapter will briefly outline treatment design and results of modern adjuvant trials for node-negative breast cancer.

Keywords

Placebo Toxicity Europe Estrogen Leukemia 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bonadonna G (Guest ed) (1986) Breast cancer, part I.Semin Oncol 13: 383–449Google Scholar
  2. 2.
    Bonadonna G (Guest ed) (1987) Breast cancer, part II.Semin Oncol 14: 1–82Google Scholar
  3. 3.
    Bonadonna G, Valagussa P (1988) The contribution of medicine to the primary treatment of breast cancer.Cancer Res 48: 2314–2324.PubMedGoogle Scholar
  4. 4.
    Bonadonna G, Valagussa P (1988) New prognostic variables in primary breast cancer: how useful to clinicians?Oncol J Club 1: 12–14Google Scholar
  5. 5.
    Bonadonna G, Valagussa P (1989) Role of chemotherapy in stage I breast cancer. In: De Vita VT, Hellman S, Rosenberg SA (eds) Important advances in oncology, 1989. Lippincott, Philadelphia pp 151–160Google Scholar
  6. 6.
    Bonadonna G, Valagussa P, Zambetti M, Buzzoni R, Moliterni A (1987) Milan adjuvant trials for stage I–II breast cancer. In: Salmon SE (ed) Adjuvant therapy of cancer V. Grune and Stratton, Orlando, pp 211–221Google Scholar
  7. 7.
    Bonadonna G, Zambetti M, Valagussa P, Bignami P, Di Fronzo G, Silvestrini R (1986) Adjuvant CMF in node negative breast cancer.Proc Am Soc Clin Oncol 5: 74Google Scholar
  8. 8.
    Breast Cancer Trials Committee (1987) Adjuvant tamoxifen in the management of operable breast cancer: the Scottish trial.Lancet 2: 171–175Google Scholar
  9. 9.
    Clark GM, Dressier LG, Owens MA, Pounds G, Oldaker T, McGuire WL (1988) DNA flow cytometry predicts time to recurrence and survival in 606 axillary node-negative breast cancer patients.Proc Am Soc Clin Oncol 7: 14Google Scholar
  10. 10.
    Clark GM, McGuire WL, Hubay CA, Pearson OH, Marshall JS (1983) Progesterone receptor as a prognostic factor in stage II breast cancer.N Engl J Med 309: 1343–1347PubMedCrossRefGoogle Scholar
  11. 11.
    Cline MJ, Battifora H, Yokata J (1987) Proto-oncogene abnormalities in human breast cancer: correlation with anatomic features and clinical course of disease.J Clin Oncol 5: 999–1006PubMedGoogle Scholar
  12. 12.
    Early Breast Cancer Trialists’Collaborative Group (1988) The effects of adjuvant tamoxifen and of cytotoxic therapy on mortality in early breast cancer: an overview of 61 randomized trials among 28,896 women.N Engl J Med 1681–1692Google Scholar
  13. 13.
    Fisher B, Brown A, Wolmark N, Redmond C, Wickerham DL, Wittliff J, Dimitrov N, Legault-Poisson S, Schipper H, Prager D, and other NSABP Investigators (1987) Prolonging tamoxifen therapy for primary breast cancer. Findings from the national surgical adjuvant breast and bowel project clinical trial.Ann Intern Med 106: 649–654PubMedGoogle Scholar
  14. 14.
    Fisher B, Ravdin RG, Ausman RK, Slack NH, Moore GE, Noer RJ, and Cooperating Investigators (1968) Surgical adjuvant chemotherapy in cancer of the breast: results of a decade of cooperative investigation.Ann Surg 168: 337–356PubMedCrossRefGoogle Scholar
  15. 15.
    Fisher B, Redmond CK, Wolmark N, and NSABP Investigators (1987) Long term results from NSABP trials of adjuvant therapy for breast cancer. In: Salmon SE (ed) Adjuvant therapy of cancer V. Grune and Stratton, Orlando, pp 283–295Google Scholar
  16. 16.
    Fisher B, Slack N, Katryck D, Wolmark N (1975) Ten-year follow-up results of patients with carcinoma of the breast in a co-operative clinical trial evaluating surgical adjuvant chemotherapy.Surg Gynecol Obstet 140: 528–534PubMedGoogle Scholar
  17. 17.
    Levack PA, Mullen P, Anderson TJ, Miller WR, Forrest APM (1987) DNA analysis of breast tumor fine needle aspirates using flow cytometry.Br J Cancer 56: 643–646PubMedCrossRefGoogle Scholar
  18. 18.
    McGuire WL (1987) Prognostic factors for recurrence and survival in human breast cancer.Breast Cancer Res Treat 10: 5–9PubMedCrossRefGoogle Scholar
  19. 19.
    Merkel DE, Dressier LG, McGuire WL (1987) Flow cytometry, cellular DNA content, and prognosis in human malignancy.J Clin Oncol 5: 1690–1703PubMedGoogle Scholar
  20. 20.
    Meyer JS, Friedman E, McCrate MM, Bauer WC (1983) Prediction of early course of breast carcinoma by thymidine labeling.Cancer 51: 1879–1886PubMedCrossRefGoogle Scholar
  21. 21.
    NCI Clinical Alert, May 18, 1988Google Scholar
  22. 22.
    Nolvadex Adjuvant Trial Organization (1985) Controlled trial of tamoxifen as single adjuvant agent in management of early breast cancer. Analysis at six years.Lancet 1: 836–840Google Scholar
  23. 23.
    Silvestrini R, Daidone MG, Gasparini G (1985) Cell kinetics as a persisting prognostic marker in node negative breast cancer.Cancer 56: 1982–1987PubMedCrossRefGoogle Scholar
  24. 24.
    Silvestrini R, Daidone MG, Valagussa P, Mezzanotte G, Bonadonna G (1989) Cell kinetics as a prognostic indicator in node-negative breast cancer,Euz J Cancer Clin Oncol 25: 1165–1171CrossRefGoogle Scholar
  25. 25.
    Tandon A, Clark G, Ullrich A, Slamon D, McGuire W (1988) Overexpression of the HER-2/neu oncogene predicts relapse and survival in stage II human breast cancers.Proc Am Soc Clin Oncol 7: 14Google Scholar
  26. 26.
    The Clinical Cancer Letter (1988), vol 11, No 5Google Scholar
  27. 27.
    Tubiana M, Pejovic MH, Chavaudra N, Contesso G, Malaise EP (1984) The long-term prognostic significance of the thymidine labelling index in breast cancer.Int J Cancer 33: 441–445PubMedCrossRefGoogle Scholar
  28. 28.
    Valagussa P, Bignami P, Buzzoni R, Di Fronzo G, Andreola S, Rilke F, Bonadonna G, Veronesi U (1984) Are estrogen receptors alone a reliable prognostic factor in node negative breast cancer? In: Jones SE, Salmon SE (eds) Adjuvant therapy of cancer IV. Grune and Stratton, Orlando, pp 407–415Google Scholar
  29. 29.
    Valagussa P, Bonadonna G, Veronesi U (1978) Patterns of relapse and survival following radical mastectomy. Analysis of 716 consecutive patients.Cancer 41: 1170–1178PubMedCrossRefGoogle Scholar
  30. 30.
    Valagussa P, Tancini G, Bonadonna G (1987) Second malignancies after CMF for resectable breast cancer.J Clin Oncol 5: 1138–1142PubMedGoogle Scholar
  31. 31.
    Williams CJ, Buchanan RB, Hall V, Taylor I, Cooke T, Nicholson R, Griffiths K (1987) Adjuvant chemotherapy for Tl-2, NO, M0 estrogen receptor negative breast cancer: preliminary results of a randomized trial. In: Salmon SE (ed) Adjuvant therapy of cancer V. Grune and Stratton, Orlando, pp 233–241Google Scholar

Copyright information

© Springer-Verlag Berlin · Heidelberg 1991

Authors and Affiliations

  • P. Valagussa
    • 1
  • R. Silvestrini
    • 1
  • G. Bonadonna
    • 1
  1. 1.Istituto Nazionale TumoriMilanItaly

Personalised recommendations