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November 20, 1997

Chemotherapy a benefit in most cases of breast cancer, new Fisher study shows

Results of a new study by the National Surgical Adjuvant Breast and Bowel Project, combined with earlier NSABP findings, indicate that nearly all breast cancer patients could benefit from chemotherapy.

The new study, led by Pitt researcher and NSABP founder Bernard Fisher, indicates that chemotherapy plus the anti-estrogen drug tamoxifen is more effective than tamoxifen alone in treating women with breast cancers that:

* Have not spread to the underarm lymph nodes, and

* Are not estrogen receptor-positive (that is, the cancer does not bind with estrogen).

The new, multi-center study, conducted by the NSABP between October 1988 and March 1993, involved 2,306 breast cancer patients. Results were published Nov. 19 in the Journal of the National Cancer Institute.

Survival rates for breast cancer patients who received chemotherapy in addition to tamoxifen were 4 to 6 percent better than for patients who just received tamoxifen, depending on the women's ages.

Combined with earlier NSABP findings, the new research shows that all breast cancer patients should consider chemotherapy — regardless of age, tumor size, and whether the cancer has spread to the lymph system or is estrogen receptor-positive, said Fisher.

Referring to the latest study, Fisher said: "When you see numbers like 4 or 5 or 6 percent [better survival rates], some people may ask, 'Well, is that great enough to justify giving these women chemotherapy for several months?' And my answer is that, first of all, the drugs themselves are relatively non-toxic. Secondly, it's easy for someone who doesn't have breast cancer to say that 4 to 6 percent doesn't represent much of a difference.

"But if you're a patient, and you could have 4 to 6 more chances out of 100 of staying alive and free of cancer, would you want to take it?" In the new study, women first underwent mastectomy or lumpectomy surgery plus breast irradiation. Then they were randomly assigned to one of three treatment groups: tamoxifen alone; tamoxifen plus methotrexate combined with fluorouracil (MFT) chemotherapy; and tamoxifen plus a combination of cyclophosphamide, methotrexate and flurouracil (CMFT).

After five years of follow-up, chemotherapy plus tamoxifen improved disease-free survival rates (which were 90 percent for MFT and 89 percent for CMFT versus 85 percent for tamoxifen alone).

— Bruce Steele

Filed under: Feature,Volume 30 Issue 7

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