Primary systemic therapy for operable breast cancer - 10-year survival data after chemotherapy and hormone therapy

Abstract

Summary Between 1984 and 1990, 94 women presenting to the Edinburgh Breast Unit with operable breast cancer of 4 cm or greater in diameter (T2, T3, NO, Ni, MO) were given preoperative systemic therapy. Initially, all women received hormone therapy, with CHOP (cyclophosphamide 1 g m-2, doxorubicin 50 mg m-2, vincristine 1.4 mg m-2 to a maximum of 2 mg and prednisolone 40 mg per day orally for 5 days) chemotherapy being administered to those who failed to respond by 3 months. After April 1987, first-line hormone therapy was only offered to women with oestrogen receptor (ER)-moderate/-rich (> 20 fmol mg-1 protein) tumours, and CHOP was reserved for those women whose tumours failed to respond to hormone therapy and for those with ER-negative/-poor tumours. Response data have been published previously (Anderson et al, 1991). After a median follow-up of 7.5 years, there is no difference in survival between those women given initial hormone therapy and those given chemotherapy, with neither group having yet reached its median survival. The two key factors that predicted for a poor survival were the number of involved axillary nodes after preoperative systemic therapy (P < 0.00001) and a lack of response to preoperative therapy (P < 0.05). These data suggest that many women with ER-moderate/-rich tumours will have a good prognosis after preoperative hormone therapy alone. However, it is possible to identify, by their post-systemic therapy axillary node status, a group of women who still have an appalling prognosis after preoperative chemotherapy or hormone therapy.

Is Nottingham prognostic index useful after induction chemotherapy in operable breast cancer?

“…Among the most useful of these are the presence and number of axillary lymph-node metastasis, tumour size, histological type and SBR grade. The most powerful is indisputably the node involvement with a prognosis inversely related to the number of involved nodes, even after neoadjuvant chemotherapy and whatever the treatment administered (Cameron et al, 1997;Pierga et al, 2000;Cure et al, 2002). SBR grading is also by itself a prognostic parameter; survival was worse in patients with poorly differentiated tumours (grades II and III) compared with well-differentiated grade I tumours (Simpson et al, 2000;Latinovic et al, 2001;Amat et al, 2002).…”

Immediate Gene Expression Changes After the First Course of Neoadjuvant Chemotherapy in Patients with Primary Breast Cancer Disease

“…The PST in general do not offer a survival advantage over standard adjuvant treatment, but may identify patients with a pathologically confirmed complete response (45,46). This clinical response to PST is associated with improved survival (50,54,55) and reflects a great benefit to ϳ14% of the PST-treated patients. Studies elaborating PST have demonstrated that early gene expression changes are significantly associated with clinical response (56,57).…”

Phase 2 randomized trial of primary endocrine therapy versus chemotherapy in postmenopausal patients with estrogen receptor‐positive breast cancer

“…13 Several phase 2 studies have demonstrated the feasibility of various endocrine treatments in elderly breast cancer patients with advanced locoregional disease, thus suggesting an alternative approach to initial surgery. 14,15 Choice of patients for this strategy follows from well-established predictive and prognostic variables for response to endocrine therapy in more advanced disease, specifically the presence of ER and PgR, advanced age, and welldifferentiated tumors. Most studies have reported lower objective response and pCR rates (50%-70% and <5%-10%, respectively) than have been reported for primary chemotherapy, and the time spent on endocrine therapy required to halve the tumor volume is often longer than that with chemotherapeutic agents (>3 months).…”