Longer
Duration of Adjuvant Chemotherapy for Breast Cancer may Improve
Cancer-Free Survival
According to a recent article published in the Journal of
Clinical Oncology, 6 courses of the common chemotherapy combination
fluorouracil (5-FU), epirubicin (Ellence ®) and cyclophosphamide
(FEC) appears superior to 3 courses of the same regimen as
adjuvant therapy in premenopausal women with breast cancer.
Breast cancer claims the lives of approximately 40,000 women
annually in the United States. Researchers have been evaluating
and comparing optimal treatment regimens for patients with
all stages of breast cancer in order to improve survival.
Adjuvant therapy refers to treatment following the surgical
removal of the cancer in order to kill any cancer cells that
may have remained in the body following surgery. Different
doses and duration of adjuvant treatment are still being investigated
in patients with breast cancer that has not spread to distant
sites in the body and debate still exists over the most appropriate
treatment modalities for patients with differing disease characteristics.
Researchers from France recently conducted a clinical trial
directly comparing 3 different adjuvant treatment schedules
of the common chemotherapy combination FEC as adjuvant therapy
for breast cancer. This trial involved over 600 premenopausal
women with breast cancer that had spread to axillary (under
the arm) lymph nodes, but not to distant sites in the body.
Patients were initially treated with surgery to remove the
cancer, radiation therapy and one of three FEC regimens: 6
cycles of FEC with a dose of epirubicin of 50 milligrams per
size of the patient's body (mg/m2) (6 FEC 50), 3 cycles of
FEC 50 (3 FEC 50), or 3 cycles of FEC with an epirubicin dose
of 75 mg/m2 (FEC 75). One cycle of treatment consisted of
FEC given once every 21 days.
Ten years following therapy, cancer-free survival was 53.4%
for the group of patients treated with 6 FEC 50, 43.6% for
patients treated with the FEC 75 regimen and 42.5% for patients
treated with 3 FEC 50. Overall survival at 10 years was 64.3%
for patients treated with 6 FEC 50, 59.7% for patients treated
with FEC 75 and 56.6% for patients treated with 3 FEC 50.
There were no significant differences in side effects between
the 3 treatment groups, except loss of hair occurring more
frequently in patients treated with FEC 75. There were no
treatment-related deaths.
These researchers concluded that 6 cycles of FEC 50 appeared
more effective than 3 cycles of FEC 50 or FEC 75 in terms
of long-term cancer-free survival and slightly more effective
in overall long-term survival as adjuvant therapy in premenopausal
women with breast cancer that has spread to axillary lymph
nodes. Patients may wish to discuss the results of this trial
with their physician or the risks and benefits of participating
in a clinical trial further evaluating adjuvant therapy. 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: Fumoleau P, Kerbrat P, Romestaing P, et al. Randomized
trial comparing six versus three cycles of epirubicin-based
adjuvant chemotherapy in premenopausal, node-positive breast
cancer patients: 10-year follow-up results of the French Adjuvant
Study Group 01 Trial. Journal of Clinical Oncology. 2003;21:208-305.
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