Addition
of Paclitaxel to Standard Chemotherapy Improves Survival in
Node-Positive Localized Breast Cancer
According to a recent article published in The Journal of
Clinical Oncology, the addition of paclitaxel (Taxol ®)
to a standard chemotherapy combination doxorubicin and cyclophosphamide
appears to reduce cancer recurrences and improve survival
in women with localized breast cancer with spread to axillary
(under the arm) lymph nodes. However, increasing the doses
of doxorubicin did not affect patient outcomes.
Breast cancer is diagnosed in approximately 200,000 women
in the United States annually. Breast cancer that is confined
to the site of origin has a high cure rate following standard
therapy. Patients who only have spread of cancer to their
axillary lymph nodes are often treated with chemotherapy following
the surgical removal of their cancer. One standard chemotherapy
combination for this group of patients is doxorubicin and
cyclophosphamide. The taxanes, Taxotere ® (docetaxel) and
paclitaxel, have emerged as very active agents in the treatment
of breast cancer. Clinical trials are ongoing to directly
compare taxane-based chemotherapy regimens to other standard
regimens.
Researchers affiliated with the Cancer and Leukemia Group
B (CALGB) have recently reported the final results of a clinical
trial evaluating different chemotherapy regimens in patients
with node-positive localized breast cancer. This trial involved
over 3,000 patients who were randomly selected to initially
receive cyclophosphamide plus one of three increasing doses
of doxorubicin. Following completion of initial therapy, patients
were randomly selected to receive either further treatment
with paclitaxel or no further treatment (control group). At
5 years, the different doses of doxorubicin did not affect
the rate of cancer recurrences. Cancer-free survival was 70%
for patients treated with additional paclitaxel, compared
to 65% for patients in the control group. Overall survival
was 80% for patients treated with paclitaxel, compared to
77% for patients in the control group.
The researchers concluded that sequential addition of paclitaxel
to a standard chemotherapy combination of doxorubicin plus
cyclophosphamide improves disease free and overall survival.
Longer follow-up may demonstrate a larger difference in survival.
Recent clinical trials have demonstrated that anthracyclines
and taxanes given in a dose-dense manner (doses delivered
closely together) appears to further improve survival in the
treatment of breast cancer. Patient with node-positive breast
cancer may wish to discuss the risks and benefits of chemotherapy
consisting of taxanes and anthracyclines. Patients may also
wish to participate in a clinical trial evaluating other promising
therapeutic approaches. Two sources of information regarding
ongoing clinical trials include the National Cancer Institute
(cancer.gov) and www.eCancerTrials.com. ECancerTrials.com
also provides personalized clinical trial searches on behalf
of patients.
Reference: Henderson I, Berry D, Demetri G, 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. Journal of Clinical
Oncology. 2003; 21: 976-983.
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