Primary systemic therapy for operable breast cancer

Abstract

Summary Eighty-eight patients presenting with operable breast cancer of 4 cm or greater in diameter (T2, T3, NO, NI, MO) have received primary systemic therapy. Response was assessed following 12 weeks of systemic therapy by linear regression analysis of changes in tumour volume. Definitive locoregional surgery (mastectomy n = 82, wide local excision n = 6) was performed on completion of systemic therapy (3-6 months). Response was observed in 24 (39%) of the 61 patients who received endocrine therapy; all 24 had tumours with an oestrogen receptor (ER) concentraton of > 20 fmol mb' cytosol protein. Cytotoxic therapy was reserved for patients with tumours of ER concentration <20 fmol mg-' cytosol protein (n = 27) or when endocrine therapy had failed (n = 20). Response was observed in 34 patients (72%). The overall survival rate at 3 years was 86%, with 81% remaining free from local relapse. We propose that the treatment policy outlined in this paper should now be tested against orthodox management by controlled randomised trial.

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

“…In the remaining patients, tumour response was assessed at 12 weeks by regression analysis of the tumour volumes from weeks 4 to 12. Using 95% confidence intervals, those tumours that had a regression line with a significantly negative gradient were classified as responding, whereas those that had a significantly positive gradient were classified as progressing (Anderson et al, 1991;Cheung and Johnson, 1991). Any tumour whose regression line was not significantly deviant from the horizontal was classified as static.…”

“…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.…”

Breast Conservation Surgery after Neoadjuvant Chemotherapy in Responders in Operable Breast Carcinoma: A Better Alternative.

“…This has been reported in various studies though % increase may differ. [2,3,4,5,6] . In our study, before giving neoadjuvant chemotherapy only three [12%] patients were found eligible for breast conservation surgery, whereas sixteen [16%] were offered this surgery afterwards.…”

Dietary supplementation with L-arginine in patients with breast cancer (> 4 cm) receiving multimodality treatment: report of a feasibility study

“…The complete pathological response rate of 18% in our study occurred following chemotherapy and radiotherapy, but no comparable published data are available. However, a complete pathological response rate of 17% has been obtained in operable tumours following similar chemotherapy (Anderson et al, 1991). In their study, primary systemic therapy was used on a selective basis for patients with operable breast cancer of 4 cm or greater in diameter, i.e.…”