Adjuvant Chemotherapy for Node-Negative Breast Cancer Patients

  • G. Bonadonna
  • M. Zambetti
  • P. Valagussa
Part of the Recent Results in Cancer Research book series (RECENTCANCER, volume 115)

Abstract

Recent results have confirmed that adjuvant systemic therapies increase the relapse-free survival (RFS) and overall survival (OS) of patients with resectable breast cancer (Bonadonna and Valagussa 1988; Early Breast Cancer Trialists Collaborative Group 1988). Most of the available adjuvant results at 5 or more years are based on prospective trials designed for node-positive (N +) patients. For many years, the reluctance of research physicians to mount adjuvant trials on node-negative (N -) women was due to the uncertainty about reproducible prognostic variables upon which patient selection could be based. In fact, it should first be recalled that 15%–20% of all N — patients relapse during the first 5 years after local-regional therapy, while in the subsequent 5 years another 5–10% relapse. Therefore, the number of analyzable events are indeed few, unless specific criteria for selection of patients with a high risk of early relapse are utilized.

Keywords

Placebo Estrogen Oncol Bacillus Stratification 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Bonadonna G, Valagussa P (1988) The contribution of medicine to the primary treatment of breast cancer. Cancer Res 48: 2314–2324PubMedGoogle Scholar
  2. Caffier H, Rotte K, Haeggqwist O (1984) Adjuvant chemotherapy versus postoperative irradiation in node negative breast cancer. In: Jones SE, Salmon SE (eds) Adjuvant therapy of cancer, vol 4. Grune and Stratton, Orlando, FL, pp 417–424Google Scholar
  3. Contesso G, Mouriesse H, Friedman S, Genin J, Sarrazin D, Rouessé J (1987) The im-portance of histologic grade in long-term prognosis of breast cancer. A study of 1010 patients, uniformly treated, at the Institute Gustave Roussy. J Clin Oncol 5: 1378- 1386Google Scholar
  4. Crowe JP, Hubay CA, Pearson OH, Marshall JS, Rosenblatt J, Mansour EG, Hermann RE, Jones JC, Flynn WJ, McGuire WL, and Participating Investigators (1982) Estrogen receptor status as a prognostic indication for stage I breast cancer patients. Breast Cancer Res Treat 2: 171–176PubMedCrossRefGoogle Scholar
  5. Davis BW, Gelber RD, Goldhirsh A, Hartmann WH, Locher GW, Reed R, Golauh R, Save-Soderbergh J, Holloway L, Russel I, Rudenstam CM, for the Ludwig Breast Cancer Study Group (1986) Prognostic significance of tumor grade in clinical trials of adjuvant therapy for breast cancer with axillary lymph node metastasis. Cancer 58: 2662–2670PubMedCrossRefGoogle Scholar
  6. 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 319: 1681–1692CrossRefGoogle Scholar
  7. Fisher B, Wolmark N, Bauer M, Redmond C, Gebhardt M (1981) The accuracy of clinical nodal staging and of limited axillary dissection as a determinant of histologic nodal status in carcinoma of the breast. Surg Gynecol Obstet 152: 765–772PubMedGoogle Scholar
  8. Fisher ER, Redmon C, Fisher B, and participating NSABP Investigators (1983) Pathologic findings from the National Surgical Adjuvant Breast Project. VIII. Relationship of chemotherapeutic responsiveness to tumor differentiation. Cancer 51: 181–191PubMedCrossRefGoogle Scholar
  9. Fisher B, Fisher ER, Redmond C, Brown A, and Contributing NSABP Investigators (1986) Tumor nuclear grade, estrogen and progesterone receptors: their value alone or in combination as indicators of outcome following adjuvant therapy for breast cancer. Breast Cancer Res Treat 7: 147–160PubMedCrossRefGoogle Scholar
  10. 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, vol 5. Grune and Stratton, Orlando, pp 283–295Google Scholar
  11. Hery M, Gioanni J, Lelanne CM, Namer M, Courdi A (1987) The DNA labelling index: a prognostic factor in node-negative breast cancer. Breast Cancer Res Treat 9: 207–211PubMedCrossRefGoogle Scholar
  12. Jackez R, Kolb R, Reiner G, Schemper M, Rainer H, Dittrich C, Reiner A (1987) Adjuvant chemotherapy in node-negative breast cancer patients. In: Salmon SE (ed) Adjuvant therapy of cancer, vol 5. Grune and Stratton, Orlando, pp 223–231Google Scholar
  13. Mansi JL, Berger U, Easton D, McDonnell T, Redding WH, Gazet JC, McKinna A, Powles TJ, Coombes RC (1987) Micrometastases in bone marrow in patients with primary breast cancer: evaluation as an early predictor of bone metastases. Br Med J 295: 1093–1096CrossRefGoogle Scholar
  14. McGuire WL (1987) Prognostic factors for recurrence and survival in human breast cancer. Breast Cancer Res Treat 10: 5–9PubMedCrossRefGoogle Scholar
  15. Merkel DE, Dressier LG, McGuire WL (1987) Flow cytometry, cellular DNA content, and prognosis in human malignancy. J Clin Oncol 5: 1690–1703PubMedGoogle Scholar
  16. Meyer JS (1986) Cell kinetics in selection and stratification of patients for adjuvant therapy of breast carcinoma. NCI Monogr 1: 25–28PubMedGoogle Scholar
  17. Morrison JM, Howell A, Grieve RJ, Monnypenny IJ, Walker R, Kelly KA, Waterhouse JA (1987) The West Midlands Oncology Association Trials of adjuvant chemotherapy for operable breast cancer. In: Salmon SE (ed) Adjuvant therapy of cancer, vol 5. Grune and Stratton, Orlando, pp 311–318Google Scholar
  18. Nissen-Meyer R, Host H, Kjellgren K, Mansson B, Norm T (1987) Neoadjuvant chemotherapy in breast cancer: as single perioperative treatment and with supplementary long-term chemotherapy. In: Salmon SE (ed) Adjuvant therapy of cancer, vol 5. Grune and Stratton, Orlando, pp 253–261Google Scholar
  19. Senn HJ, Barett-Mahler R, for the OSAKO and SAKK Groups (1987) Update of Swiss adjuvant trials with LMF and CMF in operable breast cancer. In: Salmon SE (ed) Adjuvant therapy of cancer, vol 5. Grune and Stratton, Orlando, pp 243–252Google Scholar
  20. Silvestrini R, Daidone MG, Di Fronzo G, Morabito A, Valagussa P, Bonadonna G (1986) Prognostic implication of labeling index versus estrogen receptors and tumor size in node-negative breast cancer. Breast Cancer Res Treat 7: 161–169PubMedCrossRefGoogle Scholar
  21. 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
  22. 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, vol 4. Grune and Stratton, Orlando, pp 407–415Google Scholar
  23. 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, vol 5. Grune and Stratton, Orlando, pp 233–241Google Scholar

Copyright information

© Springer-Verlag Berlin · Heidelberg 1989

Authors and Affiliations

  • G. Bonadonna
    • 1
  • M. Zambetti
    • 1
  • P. Valagussa
    • 1
  1. 1.Istituto Nazionale TumoriMilanoItaly

Personalised recommendations