Simplifying Guidelines: We Only Need One Adjuvant Chemotherapy Regimen for Breast Cancer

2012 ◽  
Vol 10 (7) ◽  
pp. 797-798
Author(s):  
Harold J. Burstein
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Chemotherapy Regimen ◽  
Adjuvant Chemotherapy Regimen

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

2003 ◽  
Vol 21 (6) ◽  
pp. 976-983 ◽  
Author(s):  
I. Craig Henderson ◽  
Donald A. Berry ◽  
George D. Demetri ◽  
Constance T. Cirrincione ◽  
Lori J. Goldstein ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Estrogen Receptor ◽  
Adjuvant Chemotherapy ◽  
Confidence Interval ◽  
Chemotherapy Regimen ◽  
Disease Free Survival ◽  
Free Survival ◽  
Adjuvant Chemotherapy Regimen ◽  
Disease Free

Purpose: This study was designed to determine whether increasing the dose of doxorubicin in or adding paclitaxel to a standard adjuvant chemotherapy regimen for breast cancer patients would prolong time to recurrence and survival. Patients and Methods: After surgical treatment, 3,121 women with operable breast cancer and involved lymph nodes were randomly assigned to receive a combination of cyclophosphamide (C), 600 mg/m2, with one of three doses of doxorubicin (A), 60, 75, or 90 mg/m2, for four cycles followed by either no further therapy or four cycles of paclitaxel at 175 mg/m2. Tamoxifen was given to 94% of patients with hormone receptor–positive tumors. Results: There was no evidence of a doxorubicin dose effect. At 5 years, disease-free survival was 69%, 66%, and 67% for patients randomly assigned to 60, 75, and 90 mg/m2, respectively. The hazard reductions from adding paclitaxel to CA were 17% for recurrence (adjusted Wald χ2 P = .0023; unadjusted Wilcoxon P = .0011) and 18% for death (adjusted P = .0064; unadjusted P = .0098). At 5 years, the disease-free survival (± SE) was 65% (± 1) and 70% (± 1), and overall survival was 77% (± 1) and 80% (± 1) after CA alone or CA plus paclitaxel, respectively. The effects of adding paclitaxel were not significantly different in subsets defined by the protocol, but in an unplanned subset analysis, the hazard ratio of CA plus paclitaxel versus CA alone was 0.72 (95% confidence interval, 0.59 to 0.86) for those with estrogen receptor–negative tumors and only 0.91 (95% confidence interval, 0.78 to 1.07) for patients with estrogen receptor–positive tumors, almost all of whom received adjuvant tamoxifen. The additional toxicity from adding four cycles of paclitaxel was generally modest. Conclusion: The addition of four cycles of paclitaxel after the completion of a standard course of CA improves the disease-free and overall survival of patients with early breast cancer.

An Intensive Sequenced Adjuvant Chemotherapy Regimen for Breast Cancer

1993 ◽  
Vol 11 (1) ◽  
pp. 6-9 ◽  
Author(s):  
Sushil Bhardwaj ◽  
James F. Holland ◽  
Larry Norton
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Chemotherapy Regimen ◽  
Adjuvant Chemotherapy Regimen

scholarly journals Effectiveness of an Adjuvant Chemotherapy Regimen for Early-Stage Breast Cancer

JAMA Oncology ◽  
2015 ◽  
Vol 1 (9) ◽  
pp. 1311 ◽  
Author(s):  
Takeo Fujii ◽  
Fanny Le Du ◽  
Lianchun Xiao ◽  
Takahiro Kogawa ◽  
Carlos H. Barcenas ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Chemotherapy Regimen ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Adjuvant Chemotherapy Regimen

Primary tumor and patient characteristics in breast cancer as predictors of adjuvant chemotherapy regimen: A regression model

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e11632-e11632
Author(s):  
V. Francescutti ◽  
F. Farrokhyar ◽  
R. Tozer ◽  
B. Heller ◽  
P. Lovrics ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Logistic Regression ◽  
Adjuvant Chemotherapy ◽  
Regression Model ◽  
Hormonal Therapy ◽  
Chemotherapy Regimen ◽  
Univariate Analysis ◽  
Stepwise Logistic Regression ◽  
Adjuvant Radiation ◽  
Tumor Characteristics

e11632 Background: Adjuvant chemotherapy is used to reduce the risk of recurrence of breast cancer. This study was undertaken to determine which patient and tumor characteristics are important in guiding the choice of adjuvant chemotherapy. Methods: A retrospective review was undertaken of patients diagnosed with breast cancer (stages I-III) at a regional cancer center from 2004–7. Patient and tumor characteristics were identified and chemotherapy regimens compared. Binary logistic regression analysis was performed to the choice of FEC/D, CEF, AC/T, or ddAC/T against AC or CMF, or the choice of chemotherapy to hormonal therapy only. Univariate analysis was used to select factors (p<0.1) for entry into a multivariate stepwise logistic regression model using the forward method. Odds ratios with 95% CI were calculated. A p-value of < 0.05 was significant and comparisons were two tailed. Results: Model 1 (n=871) included regimen (AC or CMF vs. aggressive regimen) as the dependant variable. Indicators of choice of aggressive regimen were higher stage [OR 4.7 (CI 3.3, 6.8)], positive nodes [2.5 (1.6, 3.8)], negative PR [2.1 (1.4, 3.1)], higher grade [1.4 (1.0, 1.8)], and age [0.91 (0.88, 0.92)]. Model 2 (n=640) involved choice of any regimen (chemotherapy vs. hormonal therapy only) as the dependant variable. Indicators of choice of chemotherapy were higher stage [7.19 (2.8, 18.4)], higher grade [7.02 (3.3, 14.8)], positive nodes [3.25 (0.98, 10.77)], age [0.85 (0.81, 0.90)], and ER negativity [0.04 (0.004, 0.37)]. Factors not significant in both models were: family history, comorbidities (renal/hepatic dysfunction, diabetes, cardiac history, or neuropathy), treating medical oncologist, histology, Her2/neu, > 3 positive nodes, ratio of positive to total nodes, multicentricity, multifocality, and positive margin status. Conclusions: This study verifies known important factors for choice of chemotherapy regimen as found in current guidelines, quantifies their effects at our center, and excludes others thought to be important. Further studies are required to confirm these results both nationally and internationally, where risk stratification may be different, and if variables predicting adjuvant radiation therapy are similar. No significant financial relationships to disclose.

scholarly journals Adult Medulloblastoma Demographic, Tumor and Treatment Impact since 2006: A Canadian University Experience

2021 ◽  
Vol 28 (4) ◽  
pp. 3104-3114
Author(s):  
Maria Camila Quinones ◽  
Karl Bélanger ◽  
Émilie Lemieux Blanchard ◽  
Bernard Lemieux ◽  
Jean-Paul Bahary ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Chemotherapy Regimen ◽  
Adult Population ◽  
Extent Of Resection ◽  
Primary Brain Tumor ◽  
Adult Patients ◽  
Adult Medulloblastoma ◽  
First Line Therapy ◽  
Adjuvant Chemotherapy Regimen ◽  
Impact On Survival

Medulloblastoma is an aggressive primary brain tumor that is extremely rare in adults; therefore, prospective studies are limited. We reviewed the information of all MB patients treated at the CHUM between 2006 and 2017. We divided our cohort by age and further divided adult patients (53%) in two groups, those diagnosed between 2006–2012 and 2013–2017. In our adult population, median follow up was 26 months and SHH-activated MB comprised 39% of tumors. Adult 5yOS was 80% and first-line therapy led to a 5yPFS of 77%. The absence of radiosensitizing chemotherapy (100% vs. 50%; p = 0.033) negatively influenced 5yPFS. 96% of adult patients received radiotherapy and 48% of them received concomitant radiosensitizing chemotherapy. Complete surgical resection was performed on 85% of adults, but the extent of resection did not have a discernable impact on survival and did not change with time. Adjuvant chemotherapy did not clearly affect prognosis (5yOS 80% vs. 67%, p = 0.155; 5yPFS 78% vs. 67%, p = 0.114). From 2006–2012, the most common chemotherapy regimen (69%) was Cisplatinum, Lomustine and Vincristine, which was replaced in 2013 by Cisplatinum, Etoposide and Cyclophosphamide (77%) with a trend for worse survival. Nine patients recurred and seven of these (78%) were treated with palliative chemotherapy. In conclusion, we did not identify prognostic demographic or tumor factors in our adult MB population. The presence of radiosensitizing chemotherapy was associated with a more favorable PFS. Cisplatinum, Lomustine and Vincristine regimen might be a better adjuvant chemotherapy regimen.

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