Treatment May Cut Recurrence of Breast Cancer
The period of time when women with early-stage breast cancer remain free of disease may be enhanced by additional therapy after primary treatment, according to three new studies, the National Cancer Institute announced Thursday.
In a highly unusual move, the institute released the findings before publishing them in a medical journal or presenting them to other researchers at a scientific meeting, which is the traditional and accepted procedure.
For the record:
12:00 a.m. May 21, 1988 For the Record
Los Angeles Times Saturday May 21, 1988 Home Edition Part 1 Page 2 Column 1 National Desk 2 inches; 43 words Type of Material: Correction
In a story on breast cancer published in Friday’s editions of The Times, a reference to women whose tumors do not contain so-called estrogen receptors was incorrect. The sentence should have said the absence of estrogen receptors usually indicates a poorer prognosis and their presence a better prognosis.
“This is an important public health matter,” Dr. Vincent DeVita, director of the institute, said in a written statement. He emphasized that human studies could no longer ethically be continued using a control group--that is, a group not receiving the additional treatment.
Need for Announcement
“We cannot delay informing them and their physicians that additional treatment beyond surgery and/or radiotherapy may be beneficial,” DeVita said.
The institute cautioned, however, that “because there are recognized risks and expenses of adjuvant treatment, as well as strong evidence of benefit for many women, each patient should discuss her treatment options with her physician.”
Long-term follow-up also will be necessary to discern whether the treatments actually increase the life expectancy of breast-cancer patients, not just their disease-free survival, said Dr. John A. Glaspy, an oncologist at UCLA Medical Center and a member of the study group.
The institute said a “clinical alert” was sent earlier this week to 13,000 cancer specialists and cancer organizations, informing them of the study results.
An estimated 135,000 American women will get breast cancer this year and 42,000 will die from the disease, the institute said. One in 10 women will develop breast cancer in her lifetime, the agency said.
More than 60,000 women in this country are found to have early breast cancer every year, defined as cancer that has not spread beyond the breast into the lymph nodes. Although these women have a generally favorable outlook, about 30% suffer recurrences, the institute said.
Support European Research
DeVita said the studies, which were funded by the institute, support a larger body of research from Europe, specifically Italy and Scotland, showing that women with early-stage breast cancer that has not spread to lymph nodes can be helped by additional chemotherapy, hormonal therapy or both after primary treatment. Primary treatment usually involves surgery or surgery and radiation.
“This is an extremely important finding,” said Dr. Francine Halberg, a radiation oncologist at UC San Francisco Medical Center.
One of the studies involved 679 patients whose cancer had not spread beyond the breast and whose tumors did not contain so-called estrogen receptors, whose presence usually indicates a poorer prognosis. The primary treatment included a total mastectomy, in which the breast and underarm lymph nodes were removed, or lumpectomy, in which just the lump and underarm nodes were removed, followed by radiation.
Researchers found that patients who received a chemotherapy regimen--using methotrexate with 5-fluorouracil (5-FU), followed by leucovorin--had “a much better” disease-free survival rate four years after primary treatment, 80% versus 71%, than those who received no additional therapy, the institute said.
‘Controllable Toxicities’
“The results clearly show a prolonged disease-free survival in all women who received the chemotherapy, with moderate and easily controllable toxicities,” said Dr. Bernard Fisher, professor of surgery at the University of Pittsburgh and chairman of the National Surgical Adjuvant Breast and Bowel Project, which conducted the study.
“Treatment was beneficial regardless of age, although women over 50 actually benefited more,” Fisher said. “This finding places in question the prevailing theory that chemotherapy is worthless for post-menopausal node-negative breast cancer patients.”
The researchers, noting that age may be a factor, also determined that in the group that did not receive additional therapy, women under 50 had poorer disease-free survival after four years than those older. The figures were 66% versus 78%.
About 75% of all breast cancers develop in women who are past menopause.
Drug From Hormonal Therapy
A second study conducted by the same project studied 2,644 node-negative women whose tumors contained estrogen receptors and found that additional therapy using tamoxifen, an anti-estrogen drug used in hormonal therapy, improved disease-free survival, contrasted with no additional therapy.
Disease-free survival with the hormone was 82%, versus 77% in control groups on a placebo, which usually is a medically worthless sugar pill. The institute said the hormone helped reduce the spread of primary breast cancer cells in the breast and in other parts of the body. Researchers said the benefit was seen in the younger and older age groups.
A third random study was made of about 350 node-negative patients at increased risk of recurrence--either with or without estrogen receptors--whose tumors were larger than three centimeters.
Primary treatment included a total mastectomy with underarm lymph node removal. Additional treatment with combination chemotherapy using CMFP (cyclophosphamide, methotrexate, 5-FU and prednisone) “significantly reduced the chance of recurrence,” the institute said.
Disease-free survival three years after treatment was 84% for those who received chemotherapy and 67% for those who did not, the institute said.
