Adjuvant Chemoimmunotherapy with LMF + BCG in Node-Negative and Node-Positive Breast Cancer: 8 Year Results

  • H. J. Senn
  • W. F. Jungi
  • R. Amgwerd
  • E. Hochuli
  • J. Ammann
  • G. Engelhart
  • C. Heinz
  • A. Wick
  • F. Enderlin
  • G. Creux
  • B. Simeon
  • R. Lanz
  • R. Bigler
  • S. Seiler
Part of the Recent Results in Cancer Research book series (RECENTCANCER, volume 96)

Abstract

Since medium- to long-term survival expectancy, and thus mortality, for patients with operable breast cancer have remained essentially unchanged during the past 40–50 years in most countries, increasing numbers of clinical adjuvant studies have emerged during the past decade (reviewed in [3, 16]), prompted particularly by early optimistic reports from the NSABP and Milan groups [1, 5]. Most such investigations included only node-positive (N+) patients. We, however, felt the need to also incorporate (on a stratified basis) histologically node-negative (N−) women for the following three reasons: (1) our observation of a lower regional relapse-free survival (RFS) and overall survival (OAS) in N− patients [14] than is usually cited in the literature; (2) our assumption that N− patients with truly “minimal postoperative tumor cell burden” would constitute an ideal and completely curable population to test the present concept of adjuvant systemic chemotherapy, since to date at least 25%–30% of N− patients present recurrent, mostly incurable disease within 8–10 years of mastectomy; (3) our choice of a well-tolerated adjuvant regimen without the potential of hair-loss or significant gastrointestinal upset. Immunostimulation with bacillus Calmette-Guérin (BCG) was added to the chemotherapy (leukeran, methotrexate, fluorouracil — CMF) based on earlier claims that this treatment would “counter-balance” immunodepressive effects of cytotoxic treatment and potentially prolong RFS and/or OAS.

Keywords

Toxicity Leukemia Oncol Bacillus Methotrexate 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bonadonna G, Brusamolino E, Valagussa P et al. (1976) Combination chemotherapy as an adjuvant treatment in operable breast cancer. N Engl J Med 194: 405CrossRefGoogle Scholar
  2. 2.
    Bonadonna G, Valagussa P (1981) Dose response effect of adjuvant chemotherapy in breast cancer. N Engl J Med 304: 10PubMedCrossRefGoogle Scholar
  3. 3.
    Bonadonna G, Valagussa P (1982) Adjuvant therapy of primary breast cancer. In: Carter SK, Glatstein E, Livingstonee-RB (eds) Principles of cancer treatment. McGraw-Hill, New York, p 315Google Scholar
  4. 4.
    Buzdar AU, Blumenschein GR, Hortobagyi GN et al. (1980) 5-year follow up of FAC + BCG adjuvant therapy of stage II + III breast cancer. Cancer Chemother Pharm 5: 8Google Scholar
  5. 5.
    Fisher B, Wolmark N (1975) New concepts in the management of primary breast cancer. Cancer [Suppl 2] 36: 627CrossRefGoogle Scholar
  6. 6.
    Fisher B (1980) Laboratory and clinical research in breast cancer — a personal adventure. Cancer Res 40: 3863PubMedGoogle Scholar
  7. 7.
    Frei E III (1980) Dose a critical factor in cancer chemotherapy. Am J Med 69: 585PubMedCrossRefGoogle Scholar
  8. 8.
    Holdener EE, Osterwalder J, Senn HJ (1982) Zweitmalignome bei operiertem Mammakarzinom: Vergleich retro-und prospektiver Erfahrungen. Schweiz Med Wochenschr 112: 1800PubMedGoogle Scholar
  9. 9.
    Jungi WF, Alberto P, Brunner KW et al. (1981) Short-or long-term adjuvant chemotherapy of breast cancer? In: Salmon SE, Jones SE (eds) Adjuvant therapy of cancer III. Grune & Stratton, New York, p 395Google Scholar
  10. 10.
    Plotkin D, Wangh WJ (1983) Hypothesis: Discontinous chemotherapy for advanced breast cancer. Am J Clin Oncol 6: 375PubMedCrossRefGoogle Scholar
  11. 11.
    Sauter C (1983) Hat die heutige adjuvante zytostatische Chemotherapie bei radikal operiertem Mammakarzinompatientinnen versagt? Schweiz Med Wochenschr 113: 414PubMedGoogle Scholar
  12. 12.
    Senn HJ, Mayr AC (1979) Adjuvant therapy in breast cancer — Swiss cooperative studies. Cancer Treat Rev [Suppl] 6: 79CrossRefGoogle Scholar
  13. 13.
    Senn HJ (1982) Current status and indications for adjuvant chemotherapy in breast cancer. Cancer Chemother Pharmacol 8: 139PubMedCrossRefGoogle Scholar
  14. 14.
    Senn HJ, Amgwerd R, Jungi WF et al. (1982) Adjuvant Chemoimmunotherapy with LMF + BCG in N— and N+ breast cancer patient — intermediate report at 4 years. In: Mathé G, Bonadonna G, Salmon E (eds) Adjuvant therapies of cancer. Springer, Berlin Heidelberg New York, p 177 (Recnet results in cancer research 80 )Google Scholar
  15. 15.
    Senn HJ, Jungi WF, Amgwerd R et al (1983) 7-year results of adjuvant chemo(immuno)therapy with LMF/BCG in operable N— and N+ breast cancer (OSAKO-study 06/74). Second Europ Conf Clin Oncol, Amsterdam, Abstract 03–28Google Scholar
  16. 16.
    Senn HJ (1984) Adjuvante Chemotherapie beim operablen Mammakarzinom. Dtsch Med Wochenschr (in press)Google Scholar
  17. 17.
    Tancini G, Bonadonna G, Valagussa P et al. (1983) Adjuvant CMF in breast cancer: comparative 5-year results of 12 cycles vs 6 cycles. J Clin Oncol 1: 2PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin · Heidelberg 1984

Authors and Affiliations

  • H. J. Senn
    • 1
  • W. F. Jungi
    • 1
  • R. Amgwerd
    • 1
  • E. Hochuli
    • 1
  • J. Ammann
    • 1
  • G. Engelhart
    • 1
  • C. Heinz
    • 1
  • A. Wick
    • 1
  • F. Enderlin
    • 1
  • G. Creux
    • 1
  • B. Simeon
    • 1
  • R. Lanz
    • 1
  • R. Bigler
    • 1
  • S. Seiler
    • 1
  1. 1.Medizinische Klinik CKantonsspitalSt. GallenSwitzerland

Personalised recommendations