A New Advance in Breast Cancer War : Adding Taxol to Chemotherapy Will Save ‘Tens of Thousands of Lives,’ Researcher Says
Adding the anticancer drug Taxol to adjuvant chemotherapy for breast cancer can sharply increase a woman’s chances of survival, a new study has found. Among the more than 3,000 women in the study, the addition of Taxol to the regimen of women who had already had a breast removed increased their survival by 26% and reduced the risk of cancer recurrence by 22%, according to the study by the Cancer and Leukemia Group B.
“This represents the single most significant advance in the treatment of early-stage breast cancer in the past 20 years,” said Dr. Richard L. Schilsky of the University of Chicago Cancer Research Center, chairman of CALGB. “This new combination therapy has the potential to save tens of thousands of lives worldwide each year,” he told a meeting of the American Society of Clinical Oncology in Los Angeles, which ended last week.
Adjuvant chemotherapy is used for women with breast cancer involving the lymph nodes under the arms, indicating that the cancer has started to metastasize. Of the 183,000 American women each year who receive a diagnosis of breast cancer, about 75,500 are candidates for such therapy.
Currently, they are treated with a combination of the drugs doxorubicin and cyclophosphamide. In the 20 years since doxorubicin was added to the regimen, no other drug had been found that increased the success rate.
Taxol, which is known generically as paclitaxel, is already marketed for treatment of ovarian cancer and advanced breast cancer, so physicians are free to prescribe it for any other cancer they choose. Many oncologists at the Los Angeles meeting indicated they would begin using the drug immediately.
In a separate report on ovarian cancer, a European-Canadian Intergroup study of 680 women showed that a combination of Taxol and cisplatin was significantly more effective than the standard use of cisplatin and cyclophosphamide.
The group told the meeting that 77% of women in the Taxol group responded to the drugs, compared to 66% in the control group. “These data strikingly confirm the superiority of the Taxol / cisplatin combination to drive improved survival in women with ovarian cancer,” said Dr. Martine Piccart of the European Organization for Research and Treatment of Cancer in Brussels, Belgium.
Many women with breast cancer needlessly have their breasts removed because surgeons are not following federal treatment guidelines, according to researchers from the Northwestern University Medical School. According to the guidelines issued by the National Cancer Institute six years ago, about 75% of women with early-stage breast cancer are eligible for so-called breast-conserving therapy, which involves surgical removal of the tumor--a lumpectomy--followed by radiation therapy.
The guidelines indicate that age, prognosis and tumor type should not be used as criteria in choosing between a lumpectomy and a mastectomy. The only factors that point to mastectomies are large tumor size, small breast size in comparison to tumor size, early pregnancy and multiple tumors in various sites in the breast.
But in a study of 17,931 women eligible for the procedure, Dr. Monica Morrow and her colleagues found that only 44% received the breast-sparing treatment. The study, sponsored by the American College of Surgeons and the American College of Radiology, also found that surgeons were even less likely to use the procedure on women older than 60 despite the guidelines’ insistence that age should not be a factor.
The most important message from the study is, “if you are told you need a mastectomy, ask why,” Morrow said.
Older patients, in general, do not receive the aggressive treatment used on younger cancer patients--in part because physicians presume that the elderly cannot handle the toxic chemotherapy used on younger people. A new study by the NCI-sponsored Southwest Oncology Group has found that, despite the fact that half of all cancers occur among Americans older than 65, that age group is severely underrepresented in trials of new drugs.
Some drugs may, in fact, be too toxic for the elderly, but judicious selection can reduce problems, according to two papers presented at the meeting.
An international study evaluating 1,266 women with breast cancer that had spread to nodes under their arms found that adjuvant chemotherapy with cyclophosphamide, methotrexate and 5-fluorouracil was more toxic in women older than 65 than in those 65 or younger. Those older than 70 displayed the greatest toxicity, especially problems with mucosal membranes in the mouth and gastrointestinal system.
In the second study, of 44 similar women who were treated with cyclophosphamide and Adriamycin conducted at the Johns Hopkins Oncology Center, researchers found no age-related differences in toxicity.
Treatment of advanced lung cancer in the elderly is especially difficult, and physicians often prescribe only palliative therapy to relieve symptoms as the disease progresses. But a new drug may change the standard of care.
Researchers in the ELVIS research group (Elderly Lung cancer Vinorelbine Italian Study) compared two groups of elderly lung cancer patients, one receiving only the best supportive care for symptoms and the second receiving the same care plus the drug vinorelbine.
After one year, 27% of those receiving vinorelbine survived, compared to only 5% of those receiving only supportive care. The drug also showed no significant toxicity in the patients.
