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J Korean Med Assoc > Volume 46(6); 2003 > Article
Hong: Medical Treatment of Breast Cancer

Abstract

Breast cancer has the highest incidence among those occurring in Korean women. Adjuvant treatment of breast cancer aims to reduce micro-metastatic foci and to prevent relapse after surgery. Four cycles of AC showed equal survival benefits compared with 6 cycles of CMF, and it is not clear if the addition of taxane improves the survival. Adjuvant hormonal therapy shows reduction of relapse rate and mortality rate in both pre and post-menopausal women, if hormone receptors are expressed in the tumor. Metastatic breast cancer shows 3~25% long-term survival after response to chemotherapy or hormonal therapy, and thus in this situation, it is very hard to expect cure. And in advanced and metastatic breast cancer, chemotherapy is indicated in hormone-resistant breast cancer patients. However, in patients with a low probability of hormone sensitivity, in patients with very rapid progression, and in those with extensive metastases in lungs or liver, chemotherapy is the treatment of choice. The new class of chemotherapeutic agents such as tyrosine kinase inhibitors are being developed and are tried for the treatment of breast cancer with the hope of improving QOL and prolonging survival. Pre-operative chemotherapy improved not only the survival but also the local control rate. Multidisciplinary approach is strongly recommended to improve the efficacy of various therapy tools for breast cancer treatment in Korea, and the very rapid development of new treatment modalities together with the markers predicting response and prognosis is expected in the near future.

References

1. Bonadonna G, Valagussa P, Moliterni A, Zambetti M, Brambilla C. Adjuvant cyclophosphamide, methotrexate, and fluorouracil in node positive breast cancer. N Engl J Med 1995;332:901-906.

2. Fisher B, Brown A, Mamounas E, Wieand S, Robidoux A, Dimitrov NV, et al. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer : findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol 1997;15:2483-2493.

3. Early Breast Cancer Trialists' Collaborative group. Polychemotherapy for early breast cancer: an overview of the randomized trials. Lancet 1998;352:930-942.

4. Early Breast Cancer Trialists' Collaborative group. Tamoxifen for early breast cancer: an overview of the randomized trials. Lancet 1998;351:1451-1467.

5. Eifel P, Axelson JA, Costa J, Crowley J, Curran WJ Jr, Roter D, et al. National Institutes of Health Consensus Development Conference Statement: adjuvant therapy for breast cancer, November 1-3, 2000. J Natl Cancer Inst 2001;93(13):979-989.

6. Goldhirsch A, Glick JH, Gelber RD, Coates AS, Senn HJ. Meeting highlight: International consensus panel on the treatment of primary breast cancer. Seventh International Conference on Adjuvant Therapy of Primary Breast Cancer. J Clin Oncol 2001;19(18):3817-3827.

7. Henderson IC, Berry D, Demetry GD, Cirrincione CT, Goldstein LJ, Norton L, et al. Improved outcomes from adding sequential Paclitaxel but not from escalating Doxorubicin dose in an adjuvant chemotherapy regimen for patients with node-positive primary breast cancer. J Clin Oncol 2003;21(6):976-983.

8. Wood WC, Budman DR, Korzun AH, Cooper MR, Younger J, Ferree CR, et al. Dose and dose intensity of adjuvant chemo therapy for stage II, node-positive breast carcinoma. N Engl J Med 1994;330:1253-1259.

9. Muss H. Role of adjuvant endocrine therapy in early-stage breast cancer. Semin Oncol 2001;28(4):313-321.

10. Gianni L, Valagussa P, Zambetti M, Moliterni A, Capri G, Bonadonna G. Adjuvant and neoadjuvant treatment of breast cancer. Semin Oncol 2001;28(1):13-29.

11. Buzdar A. Endocrine therapy in the treatment of metastatic breast cancer. Semin Oncol 2001;28(3):291-304.

12. Thomas E, Buzdar A, Thieriault R, Singletary S, Booser D, McNeese M, et al. Role of paclitaxel in adjuvant therapy of operable breast cancer : preliminary results of prospective randomized clinical trials. Proc Am Soc Clin Oncol 2000;20:74a. (abstr 285).

13. Nabholtz J, Pienkowski T, Mackey J, et al. Phase III trial comparing TAC(docetaxel, doxorubicin, cyclophosphamide) with FAC(5-fluorouracil, doxorubicin, cyclophosphamide) in the adjuvant treatment of node positive breast cancer(BC) patients : interim analysis of the BCIRG 001. Proc Am Soc Clin Oncol 2002;21:36a. (abstr 141).

14. Early Breast Cancer Trialists' Collaborative group. Ovarian ablation in early breast cancer: overview of the randomized trials. Lancet 1996;348:1189-1196.

15. Goss PE, Strasser K. Aromatase inhibitors in the treatment and prevention of breast cancer. J Clin Oncol 2001;19:881-894.

16. Baum M. The ATAC (Arimidex, tamoxifen, alone or in combination) adjuvant breast cancer trial in postmenopausal (PM) women: ATAC Trialists' Group. Breast Cancer Res Treat 2001;69:210. (abstr).

17. Dees EC, Davidson NE. Ovarian ablation as adjuvant therapy for breast cancer. Semin Oncol 2001;28:322-331.

18. Davidson N, O'Neill A, Vukov A, Osborne C, Martino S, Abeloff M, et al. Effect of chemohormonal therapy in premenopausal node(+) receptor(+) breast cancer: An Eastern Cooperative Oncology Group phase III Intergroup trial (E5188, INT-0101). Proc Am Soc Oncol 1999;18:67a. (abstr 249).

19. Albain K, Green S, Ravdin P, Cobau C, Levine E, Osborne K, et al. Adjuvant chemohormonal therapy for primary breast cancer should be sequential instead of concurrent : initial results from intergroup trial 0100(SWOG-8814). Proc Am Soc Clin Oncol 2002;21:37a. (abstr 143).

20. Nieto Y, Champlin RE, Wingard JR, Vredenburgh JF, Elias AD, Shpall EF, et al. Status of high-dose chemotherapy for breast cancer : a review. Biol Blood Marrow Transplant 2000;6(5):476-495.

21. Berenson JR, Major P, Hortabagyi G. Relevant clinical end points in biphosphonate trials. J Clin Oncol 1998;16(9):3204-3205.

22. Pouillart P, Fumoleau P, Romieu G, Tubiana-Hulin M, Namer M, Dieras V, et al. Final Results of a Phase II Randomized, Parallel Study of Doxorubicin/Cyclophosphamide (AC) and Doxorubicin/Taxol[trade] (paclitaxel) (AT) as Neoadjuvant Treatment of Local-Regional Breast Cancer. Proc Am Soc Clin Oncol 1999.

23. Eifel P, Axelson JA, Costa J, Crowley J, Curran WJ Jr, Roter D, et al. National Institutes of Health Consensus Development Conference Statement : adjuvant therapy for breast cancer, November 1-3, 2000. J Natl Cancer Inst 2001;93(13):979-989.

24. Levine MN, Bramwell VH, Pritchard KI, Norris BD, Shepherd LE, Tu D, et al. National Cancer Institute of Canada Clinical Trials Group. Randomized trial of intensive cyclophosphamide, epirubicin, and fluorouracil chemotherapy compared with cyclophosphamide, methotrexate, and fluorouracil in premenopausal women with node-positive breast cancer. J Clin Oncol 1998;16(8):2651-2658.

25. Fossati R, Confalonieri C, Torri V, Ghislandi E, Penna A, Liberati A, et al. Cytotoxic and hormonal treatment for metastatic breast cancer : a systematic review of published randomized trials involving 31,510 women. J Clin Oncol 1998;16(10):3439-3460.

26. Sledge GW, Neuberg D, Ingle J, Martino S, Wood W. Phase III trial of doxorubicin (A) vs paclitaxel (T) vs doxorubicin + paclitaxel (A + T) as first-line therapy for metastatic breast cancer (MBC) : an intergroup trial. J Clin Oncol 2003.

27. Sapunar F, Smith IE. Neoadjuvant chemotherapy for breast cancer. Ann Med 2000;32(1):43-50.

28. Wolmark N, Wang J, Mamounas E, Bryant J, Fisher B. Preoperative chemotherapy in patients with operable breast cancer : nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst Monogr 2001;30):96-102.

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