The Clinical Scientific Basis of Adjuvant Chemotherapy in Breast Cancer

Abstract

It is possible to trace over the course of this century two main developmental pathways associated with the therapy of women with operable breast cancer. One charts the results from laboratory and clinical investigations which have permitted formulation, testing, and acceptance of an alternative biological hypothesis to replace the Halsted theory which is based on anatomical principles. That paradigmatic change accounts for the revolution in the local-regional management of the disease. The second developmental pathway associated with the therapy of breast cancer is that related to the use of systemic chemotherapy. It orginated from an awareness that only by distant disease control could there be an improvement in outcome for breast cancer patients. Acceptance of this concept has resulted in a major change in breast cancer research and treatment. It has led to the implementation of clinical trials to evaluate the efficacy of different systemic treatment regimens employed as adjuncts to operation. The first clinical trial of adjuvant therapy for breast cancer was begun in 1958 and within the past decade such controlled studies have proliferated at a furious pace. It seems appropriate to pause and reflect upon what has provided the basis for past and present efforts and to comment upon these considerations which might be employed for future efforts.

Refer to papers in References for listing of NSABP investigators and institutions contributing to these studies