Adjuvant Chemotherapy Regimens

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Adjuvant Chemotherapy Regimens

Posted 10/24/2010

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It is always somewhat disconcerting to sit in a room with other women and discover that no two people have had exactly the same treatment. Some of the differences are due to different tumor characteristics and some are due to timing. New studies are constantly being presented and evaluated and some make a difference in the standard of care. Others contribute to the overall knowledge base and, little by little, care changes.

My own history is a good example. In 1993, when I was first diagnosed with breast cancer, I was treated with oral CMF (that means that two of the drugs, methotrexate and 5FU were given by IV, and the cytoxan was given as pills) which was the current gold standard. By 2005, when my second breast cancer was diagnosed, things had changed, and dose dense CA was the treatment of choice. In 2010, there are a couple of standard treatments, and even more careful attention is being given to tailoring the choice to the individual's circumstances.

Here is a good review from Community Oncology by Dr. Julie Gralow from Seattle (note that I quoted her treatment tips a few days ago : http://bidmc.org/YourHealth/BIDMCInteractive/Blogs/LivingwithBreastCancer.aspx?entry=1096). Here is a quote and then a link. If you are at all interested in this subject, this is an excellent article.

Adjuvant chemotherapy for breast cancer: are anthracyclines out?

Julie R. Gralow, MD
The University of Washington School of Medicine, Seattle, WA

There has been considerable debate in recent years as to whether anthracyclines should be retained in adjuvant regimens for breast cancer; it has been suggested that other regimens provide at least equivalent efficacy and reduced toxcity. However, a review of extant data suggests that anthracyclines continue to play a primary role.

Future directions

The greatest advances in treating breast cancer in the foreseeable future will come from molecular profiling; it is increasingly appreciated that breast cancer is not a single disease, and we will eventually have the tools and therapies to treat it on an individualized basis. In the meantime, we are figuring out better ways to use existing drugs and regimens; we are evaluating new drugs, new versions of old drugs, and non-cross-resistant drugs to optimize regimens. We are working to incorporate biologics into effective regimens and trying to optimize supportive care strategies.

With regard to anthracyclines, Gianni and colleagues note that these drugs have been extensively tested in clinical trials over several decades and that currently there are insufficient data to recommend replacing them in adjuvant treatment.13 If a patient has a high enough risk of recurrence to warrant chemotherapy, it is hard to confidently identify a population that would not maximally benefit from an anthracycline-based (and probabltaxane-based) regimen.