Chemotherapy Effective Whether Given Before or After Breast Cancer Surgery

Giving chemotherapy before breast-conserving surgery is as effective against breast cancer recurrence as giving chemotherapy after breast-conserving surgery. These results were presented at the 2011 Breast Cancer Symposium.?

Breast-conserving surgery (also referred to as lumpectomy) involves removal of the breast cancer and some surrounding normal tissue. For some women, giving chemotherapy prior to surgery can shrink the cancer and make it easier to remove. There’s been some uncertainty, however, about whether chemotherapy followed by breast-conserving surgery is as effective against local-regional recurrence (cancer recurrence in or near the breast) as breast-conserving surgery followed by chemotherapy.?????

To evaluate whether risk of breast cancer recurrence varies by timing of chemotherapy, researchers collected information about roughly 3,000 women who underwent breast-conserving surgery and radiation therapy between 1987 and 2005. Roughly three-quarters of the patients underwent surgery first and the remaining patients underwent chemotherapy first. Women who received chemotherapy first tended to have cancers with worse prognostic features.????

Factors that were linked with an increased risk of breast cancer recurrence were young age (less than 50 years), clinical stage III cancer, grade 3 cancer, cancer that was estrogen receptor-negative, and close or positive surgical margins (cancer at or near the edge of the tissue that was surgically removed).?After accounting for tumor characteristics, risk of breast cancer recurrence was similar among women who underwent surgery first and women who underwent chemotherapy first.?

These results suggest that tumor characteristics—rather than the timing of chemotherapy—influence risk of breast cancer recurrence.?????

Reference: Mittendorf EA, Buchholz TA, Tucker SL et al. Impact of chemotherapy timing on local-regional failures in patients with breast cancer undergoing breast-conserving therapy. Paper presented at: 2011 Breast Cancer Symposium; September 8-10, 2011; San Francisco, CA. Abstract 82.?

Posted September 12, 2011

View the original article here

Herceptin Given At Same Time As Chemotherapy May Provide Most Benefit for Breast Cancer

The results of a Phase III clinical trial suggest that starting HerceptinR (trastuzumab) during chemotherapy for early-stage, HER2-positive breast cancer may be more effective than starting Herceptin after chemotherapy has been completed. These results were published in the Journal of Clinical Oncology.????

Fifteen to 20 percent of?breast cancers overexpress (make too much of) a protein known as HER2. Overexpression of this protein leads to increased growth of cancer cells and a worse breast cancer prognosis. Fortunately, the development of drugs such as Herceptin that specifically target HER2-positive cells has improved prognosis for women with HER2-targeted breast cancer.????

The optimal timing of Herceptin was evaluated in a Phase III clinical trial known as NCCTG N9831. The study enrolled women with Stage I-III HER2-positive breast cancer.? All women received chemotherapy with doxorubicin and cylophosphamide followed by paclitaxel, and some women also received Herceptin. Herceptin was started either at the same time as paclitaxel or later (after chemotherapy had been completed), and was given for a total of 52 weeks.????

Women who received both Herceptin and chemotherapy had a lower risk of cancer recurrence than women who received chemotherapy alone.?Women who started Herceptin at the same time as paclitaxel appeared to derive the most benefit. Five-year disease-free survival was 84.4% among women who received concurrent Herceptin and paclitaxel, compared with 80.1% among women who started Herceptin after finishing treatment with paclitaxel. This result did not meet the criteria for statistical significance, however, suggesting that it could have occurred by chance alone.?Starting Herceptin at the same time as paclitaxel did not appear to substantially increase the risk of side effects compared with starting Herceptin after chemotherapy had been completed.?

For women with early-stage, HER2-positive breast cancer, these results suggest that starting Herceptin during chemotherapy may produce better results than starting Herceptin after chemotherapy has been completed.?

Reference:?Perez EA, Suman VJ, Davidson NE et al. Sequential versus concurrent trastuzumab in adjuvant chemotherapy for breast cancer. Journal of Clinical Oncology. 2011;29:4491-4497.?

Posted December 4, 2011

View the original article here