CMF chemotherapy no better than ovarian ablation in preventing brst cancer recurrence

[Lani]

In ER+ patients (well known that chemo more effective in ER- patients)
Only 762 patients studied, and all brst cancer (not just her2+ brst cancer)lumped together--will read whole article and see if any her2 specific info
Did not look at AC, T chemo

23 November 2006
Ovarian ablation, chemotherapy similar for early breast cancer
Ovarian ablation and combined chemotherapy prolong the survival of premenopausal breast cancer patients with high-risk hormone receptor (HR)-positive disease to a similar extent, a randomized trial suggests.

"Although the number of events is not sufficient to claim equivalence, our results are consistent with previously published trials and with the indirect comparisons from the Early Breast Cancer Trialists Collaboration Group review," say the researchers, led by Bent Ejlertsen from Copenhagen University Hospital in Denmark.

The results are based on 762 premenopausal patients with HR-positive tumors who were deemed at high risk of recurrence as they had either axillary lymph node metastases or tumors of more than 5 cm in size.

Between 1990 and May 1998, the patients were randomly assigned to undergo ovarian ablation by irradiation or nine courses of intravenous cyclophosphamide, methotrexate, and fluorouracil (CMF) every 3 weeks.

After a median follow-up of 8.5 years, patients in the ovarian ablation group had comparable disease-free survival rates to the CMF patients (unadjusted hazard ratio [HR] = 0.99). Likewise, after a median follow-up of 10.5 years, overall survival was similar in the two groups, with a respective hazard ratio of 1.11, the researchers report in the Journal of Clinical Oncology.

Antonio Wolff and Nancy Davidson (The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA) recalled, in a related editorial, that the therapeutic efficacy of oophorectomy was first established in a Lancet publication in 1896.

They say the study is limited because it did not incorporate tamoxifen, but agree that the results echo those of previous research, and say the conclusion "is likely to be correct."



J Clin Oncol 2006; 24: 4956-4962, 4949-4951

Link:
http://www.jco.org/cgi/content/abstract/24/31/4956

[Lani]

EDITORIALS
Still Waiting After 110 Years: The Optimal Use of Ovarian Ablation As Adjuvant Therapy for Breast Cancer
Antonio C. Wolff and Nancy E. Davidson
JCO Nov 1 2006: 4949–4951. [Full Text] [PDF]

Comments on fact that ovarian irradiation was the method of ovarian oblation used, and that tamoxifen was not used in neither the irradiated nor the
chemotherapy-treated group (as prior to late 1990s when the studies were begun, it was thought that tamoxifen should not be used in premenopausal patients)

[R.B.]

And just to complicate chemo can effectively ablate the ovaries. Well known I know but some seemed to be asking how much treatment benifit from chemo was due to ovarian ablation caused by chemo ?

I posted some links on the site earlier on this. From distant recollection there have been a few trials looking at chemo v ablation, and incidence of reoccurence where chemo has not brought about ovarian shut down.

The whole subject raises issues for younger suffers with fertility issues looking at chemo as a treatment option, especially where borderline.


RB