Adjuvant Chemoendocrine Therapies In Pre- and Postmenopausal Breast Cancer (“Can you teach an old dog new tricks?”)

  • Aron Goldhirsch
  • Monica Castiglione
  • Richard D. Gelber
Part of the ESO Monographs book series (ESO MONOGRAPHS)


Most breast cancer patients who remain disease free after local and regional treatment eventually relapse and die of or with overt metastases. This is true regardless of whether they received an appropriate local therapy. The current hypothesis ascribes the failure to obtain freedom from disease to occult micrometastatic disease already present at the time of diagnosis and first surgery [1]. This hypothesis has acquired indirect support from the results of clinical trials which showed no additional advantage in terms of disease-free or overall survival for a more radical local therapy [2,3].


Breast Cancer Overall Survival Postmenopausal Breast Cancer Postmenopausal Patient Operable Breast Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Henderson IC, Canellos GP: Cancer of the breast: the past decade. N Engl J Med 1980 (302): 17–30, 78–90PubMedCrossRefGoogle Scholar
  2. 2.
    Veronesi U, Cascinelli N, Greco M et al: Prognosis of breast cancer patients after mastectomy and dissection of internal mammary nodes. Ann Surg 1985 (202): 702–707PubMedCrossRefGoogle Scholar
  3. 3.
    Fisher B, Redmond C, Poisson R et al: Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1989 (320): 822–828PubMedCrossRefGoogle Scholar
  4. 4.
    Cole MP: Prophylactic compared with therapeutic x-ray artificial menopause. 2nd Tenovus Workshop of Breast Cancer, 1970 pp 2–11Google Scholar
  5. 5.
    Berlin Nl: Research strategy in cancer: screening, diagnosis, prognosis. Hosp Practice 1975 (10): 83–91Google Scholar
  6. 6.
    Martin DS, Fugman RA: A role of chemotherapy as an adjunct to surgery. Cancer Res 1957 (17):1098–1101Google Scholar
  7. 7.
    Martin DS: Clinical implications of the interrelationship of tumor size and chemotherapeutic response. Ann Surg 1960 (151):97–100PubMedCrossRefGoogle Scholar
  8. 8.
    Martin DS, Hayworth PE, Fugman RA: Enhanced cures of spontaneous murine mammary tumors with surgery, combination chemotherapy, and immunotherapy. Cancer Res 1970 (30): 709–716PubMedGoogle Scholar
  9. 9.
    Karrer K, Humphreys SR: Continuous and limited courses of cyclophosphamide (NSC 26271) in mice with pulmonary metastases after surgery. Cancer Chemother Rep 1967 (51): 439–449Google Scholar
  10. 10.
    Mayo JG, Laster WR, Andrews CM, Schable FM: Success and failure in the treatment of solid tumors. III. Cure of metastatic Lewis lung carcinoma with methyl-CCNU (NSC 94551) and surgery-chemotherapy. Cancer Chemother Rep 1972 (56):183–195PubMedGoogle Scholar
  11. 11.
    Martin DS, Fugman RA, Stolfi RL, et al: Solid tumor animal model therapeutically predictive for human breast cancer. Cancer Chemother Rep 1975 (59):89–109Google Scholar
  12. 12.
    Goldie JH, Coldman AJ: A mathematic model for relating the drug sensitivity of tumors to spontaneous mutation rate. Cancer Treat Rep 1979 (63): 1727–1733PubMedGoogle Scholar
  13. 13.
    Retsky MW, Wardwell RH, Swartzendruber DE, et al: Prospective computerized simulation of breast cancer: comparison of computer predictions with nine sets of biological and clinical data. Cancer Res 1987 (47): 4982–4997PubMedGoogle Scholar
  14. 14.
    Cavalli F, Pedrazzini A, Martz G, Jungi WF, Brunner KW, Goldhirsch A, Mermillod B, Alberto P: Randomized trial of 3 different regimens of combination chemotherapy in patients receiving simultaneously a hormonal treatment for advanced breast cancer. Eur J Cancer Clin Oncol 1983 (19):1615–1624PubMedCrossRefGoogle Scholar
  15. 15.
    Fisher B, Redmond C, Brown A, et al: Adjuvant chemotherapy with and without tamoxifen: five-year results from the National Surgical Adjuvant Breast and Bowel Project Trial. J Clin Oncol 1986 (4):459–471PubMedGoogle Scholar
  16. 16.
    Osborne CK: Effects of estrogens and antiestrogens on cell proliferation. Implications for treatment of breast cancer. In: Osborne CK (ed) Endocrine Therapies in Breast and Prostatic Cancer. Kluwer Academic Publishers, Boston, 1988 pp111–129CrossRefGoogle Scholar
  17. 17.
    Kaufmann M, Jonat W, Caffier H, et al: Adjuvant systemic risk adapted cytotoxic +/E#x00a7 tamoxifen therapy in women with node-positive breast cancer. In: Salmon SE (ed) Adjuvant Therapy Of Cancer V. Grune & Stratton, Orlando, 1987 pp 337–346Google Scholar
  18. 18.
    Boccardo F, Rubagotti A, Bruzzi P, et al: Chemotherapy versus tamoxifen versus chemotherapy plus tamoxifen in node-positive, estrogen receptor-positive breast cancer patients: Results of a multicentric Italian study. J Clin Oncol 1990(8):1310–1320PubMedGoogle Scholar
  19. 19.
    Falkson HC, Gray R, Wolberg WH, Falkson G: Adjuvant therapy of postmenopausal women with breast cancer- An ECOG phase III study. Proc ASCO 1989(8):19Google Scholar
  20. 20.
    Ludwig Breast Cancer Study Group: Chemotherapy with or without oophorectomy in high-risk premenopausal patients with operable breast cancer. J Clin Oncol 1985 (3):1059–1067Google Scholar
  21. 21.
    Goldhirsch A, Gelber RD for the Ludwig Breast Cancer Study Group. Adjuvant treatment for early breast cancer: The Ludwig Breast Cancer Studies. NCI Monogr 1986(1): 55–70PubMedGoogle Scholar
  22. 22.
    Kaplan EL, Meier P: Nonparametric estimation from incomplete observation. J Am Statist Assoc 1958 (53): 457–481CrossRefGoogle Scholar
  23. 23.
    Peto R, Pike MC, Armitage P, et al: Design and analysis of randomized clinical trials requiring prolonged observation of each patient. Br J Cancer 1977(35): 1–39PubMedCrossRefGoogle Scholar
  24. 24.
    Cox DR: Regression models and life tables (with discussion). J R Stat Soc B (Methodology). 1972 (34): 187–220Google Scholar
  25. 25.
    Rivkin S, Green S, Metch B, et al: Adjuvant chemotherapy (CMFVP) vs oophorectomy followed by chemotherapy (OCMFVP) for premenopausal women with ER+ operable breast cancer with positive (+) axillary lymph nodes: An Intergroup study. Proc ASCO 1991 (10): 47Google Scholar
  26. 26.
    The International Breast Cancer Study Group: Late effects of adjuvant oophorectomy and chemotherapy upon pre-menopausal breast cancer patients. Ann Oncol 1990 (1):30–35Google Scholar
  27. 27.
    Nissen-Meyer R: Primary breast cancer: The effect of primary ovarian irradiation. Ann Oncol 1991 (2):343–346PubMedGoogle Scholar
  28. 28.
    Early Breast Cancer Trialists’ Collaborative Group. 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 1988 (319): 1681–1692Google Scholar
  29. 29.
    Report on Medical Ethics. World Med Assoc Bull 1949 (1):109–111Google Scholar
  30. 30.
    Bonadonna G, Veronesi U, Brambilla C, et al: Primary’ chemotherapy to avoid mastectomy in tumors with diameters of three centimeters or more. JNCI 1990 (82): 1537–1545Google Scholar
  31. 31.
    Hellman S, Hellman DS: Of mice but not men. Problems of the randomized clinical trial. N Engl J Med 1991 (324):1585–1589PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1992

Authors and Affiliations

  • Aron Goldhirsch
    • 1
  • Monica Castiglione
    • 2
  • Richard D. Gelber
    • 3
  1. 1.Division of OncologyOspedale San Giovanni, Bellinzona, Ospedale Civico, Lugano, and Ospedale Beata VergineMendrisioSwitzerland
  2. 2.Institut für medizinische Onkologie & International Breast Cancer Study Group Operation OfficeBernSwitzerland
  3. 3.Harvard School of Public Health, and Dana-Farber Cancer InstituteHarvard Medical SchoolBostonUSA

Personalised recommendations