NIH recommends adjuvant therapies for breast cancer

Treatment with a combination of chemotherapy drugs improves survival and should be recommended for most women with localized breast cancer, according to a consensus panel convened by the National Institutes of Health. The panel also recommended hormonal therapy for women whose tumors have estrogen receptors, and radiation therapy for women who have had mastectomies and who are at high risk for recurrence of cancer.

"Clinical trials over the past ten years have contributed an enormous amount of new information about adjuvant therapies," said panel chair Patricia Eifel, professor of radiation oncology at M.D. Anderson Cancer Center in Houston. "Women with breast cancer have more treatment options and a better chance of surviving their disease than ever before. At the same time, making treatment decisions has become a more complex process for them and their physicians due to a growing list of effective options."

Hormonal therapy was recommended by the panel for women whose breast tumors contain estrogen receptors, regardless of age, menopausal status, tumor size or whether the cancer has spread to nearby lymph nodes. Five years of tamoxifen is currently the standard adjuvant hormonal therapy.

The panel noted that no data support the use of tamoxifen for longer than five years outside of a clinical trial, but that this is an important area for investigation. The panel emphasized that hormonal therapy is not indicated for women whose tumors do not have hormone receptors. The panel recommended chemotherapy with a combination of drugs for most pre- and post-menopausal women, regardless of lymph node involvement or estrogen receptor status. Including anthracycline drugs as part of chemotherapy regimens produces a small but statistically significant survival advantage over regimens that do not contain anthracyclines. However, there are not enough data to support the routine use of taxanes or dose-intensive chemotherapy.

Women who have undergone mastectomy and who have four or more cancerous lymph nodes or an advanced primary tumor benefit from post-surgical radiation, the panel concluded. The panel added that whether women with one to three cancerous lymph nodes benefit from radiation therapy is unclear, and that this question should be tested in a randomized clinical trial. PR