Adjuvant Chemoimmunotherapy with LMF + BCG in Node-Negative and Node-Positive Breast Cancer: 8 Year Results
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  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.
KeywordsBreast Cancer Clin Oncol Postmenopausal Patient Operable Breast Cancer Positive Axillary Node
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