Breast cancer may not need chemo
 

Thought provoking. Chemo for all in the face of a 15% impact is an issue that has long puzzelled me.

It also leads onto questions as to chemo v ablation for young fertile sufferers.
Ablation is reported as being as effective as chemo, which raises they question as to why do chemo if ablation is necessary afterwards where fertility continues after chemo.

A huge emotive complex and immensly important issue for hose struggling to balance the options and outcomes.

As usual dependent on exact treatment etc.

RB




http://www.mydna.com/health/breast_c...st_cancer.html


Abstract

The National Comprehensive Cancer Network, an alliance of 19 cancer centers across the country, recently revised guidelines for breast cancer treatment.

Now, the guidelines recommend that oncologists should first determine if a breast cancer patient has any of several conditions that mean his or her cancer is affected by high levels of estrogen, rather than the traditional assessment of lymph node involvement and tumor size.

If the cancer cells are sensitive to estrogen or progesterone, then drugs that block estrogen may be effective in slowing the cancer.

Chemotherapy kills all rapidly dividing cells, whether they are cancerous or not, causing hair loss, nausea and mouth sores. This treatment only helps about 15 percent of the people who receive it after the surgery to remove their tumors.

Doctors are quick to point out that although the new guidelines, which were also recently adopted in Europe, somewhat reduce the need for chemotherapy, it does not mean patients won't ever need that form of treatment.

Percentage helped by chemo
 

"Huge" is an understatement.

A.A.

Hormonal Therapy Equivalent or Superior to Standard Chemotherapy for Adjuvant Treatme
 

Re the above this is a thought provoking item.

RB.


http://professional.cancerconsultant....aspx?id=29165

ABSTRACT

Hormonal Therapy Equivalent or Superior to Standard Chemotherapy for Adjuvant Treatment of Premenopausal Localized Breast Cancer
Chemotherapy is the current standard adjuvant therapy for localized breast cancer in pre-menopausal women. For patients who have hormone responsive disease, Nolvadex® is often added following completion of adjuvant chemotherapy. There is evidence that some of the effects of adjuvant chemotherapy are not due entirely to cytotoxic anti-tumor effects but to the production of ovarian failure. Pre-menopausal women who stop menstruating after chemotherapy have been shown to have a better outcome than those who continue menstruating. Luteinizing hormone-releasing hormone (LHRH) analogs, such as goserelin, offer an alternative form of ovarian estrogen suppression for pre-menopausal women and are being extensively studied in clinical trials. Two randomized clinical trials have addressed the issue of whether ovarian ablation is comparable to adjuvant chemotherapy for the prevention of recurrences in women with localized stage I-II breast cancer. Both clinical trials, published in the December 17, 2002 issue of the Journal of Clinical Oncology, concluded that combined adjuvant therapy with goserelin and Nolvadex® was superior or at least equivalent to standard adjuvant combination chemotherapy.
In one trial, performed by Austrian researchers, over 1,000 women with hormone-responsive disease were randomly allocated to receive 3 years of goserelin plus 5 years of Nolvadex® or 6 cycles of CMF (cyclophosphamide, methotrexate and 5-FU). In patients receiving hormonal therapy, the relapse rate was 17.2%, compared to 20.8% for those receiving CMF. The local recurrence rate was 4.7% for the hormonal group and 8.0% for the CMF group. However, the number of distant recurrences without local recurrence was the same. Furthermore, there was only a trend for improvement in survival (P = 0.195). These researchers concluded that “Overall, our data suggest that the goserelin-tamoxifen (Nolvadex®) combination is significantly more effective than CMF in the adjuvant treatment of pre-menopausal patients with stage I and II breast cancer”.
The second trial was an international multi-institution study which enrolled 1,640 women with node-positive breast cancer irrespective of hormone status. Patients were randomly allocated to receive goserelin for 2 years or CMF. The researchers found that the disease-free survival was approximately 60% at 5 years for women with hormone responsive disease in both arms of the study. For women with hormone receptor negative breast cancer, the 5-year survival following CMF was approximately 65%, compared to 40% for the goserelin arm. Further analysis showed that women receiving CMF who developed amenorrhea had a survival of 70%, compared to 40% for those who did not have amenorrhea. These authors concluded that “Goserelin offers an effective, well-tolerated alternative to CMF in pre-menopausal patients with ER-positive and node-positive early breast cancer”.
Comments: These are very important clinical trials which were thoroughly discussed in an accompanying editorial. The findings are relatively clear cut in that goserelin appears to be as effective as CMF in pre-menopausal women with localized breast cancer. However, this raises the question of whether or not hormonal therapy is as good as newer regimens including taxanes and dose-dense treatment regimens. Comparisons such as the ones reported here suggest that more comparisons will need to be made with more recently developed chemotherapy regimens.

More research is needed to develop tools to help women and physicians better distingu
 

Another item of the same ilk.

All studies need treating with caution. Definitions of outcomes could arguably significantly sway results, for example including any death after reoccurence as a death from cancer. Reoccurence is clearly more likely in an untreated group, but non survival may not necessarily be linked to cancer.


RB


http://www.natlbcc.org/bin/index.asp...nid=1&depid=20

ABSTRACT

That said, several cautions are in order. While meta-analyses provide valuable information when the effectiveness of interventions is considered at the level of larger populations, they are much less useful for the purposes of devising treatment plans that fit the specific circumstances of an individual woman's specific case. [See NBCCF Fact Sheet: "What is Meant by Breast Cancer Risk".]
NBCCF is particularly concerned about several important points. The first is that we must not lose sight of the fact that over-treatment of breast cancer remains a significant problem for thousands of women each year who are given highly toxic treatments from which they will not benefit. More research is needed to develop tools to help women and physicians better distinguish between tumors with good prognoses and those with poorer prognoses so that better treatment decisions can be made at the outset. [See NBCC Fact Sheet: "Gene Expression Profile Testing".]
In addition, this study is historical to a large extent, even though the therapies it examines are still in common use. Previously diagnosed patients are different from current and future patients in some essential ways, so the same treatments may well impact them differently. For example, higher proportions of women diagnosed today than those in this study will have earlier stage diagnosis, will get breast-conserving surgery instead of mastectomy, will undergo sentinel node biopsy instead of axillary node dissection, and will have the benefit of more sophisticated testing techniques, more detailed molecular profiling of their tumors, and more targeted therapies. It is impossible to know at this point whether these differences will mean that the treatments covered in this analysis will prove to be more or less effective than others that may be available for these patients.
Finally, we are concerned about overly sensationalized and inaccurate press coverage of this study. Karen Gelmon of the British Columbia Cancer Agency in Vancouver speculated in an editorial in The Lancet that accompanied the meta-analysis that "the survival curves suggest that adjuvant systemic therapies do cure a proportion of women with early-stage breast cancer, rather than simply delaying recurrence." Reports in several newspapers around the country picked up on and exaggerated this comment by reporting that this analysis shows that these therapies can cure breast cancer. While the analysis contains much valuable information, the fact is that over 40,000 women die from breast cancer every year, in spite of the fact that these very therapies have been in use throughout the 15 years that this study covers. The National Breast Cancer Coalition looks forwad to the day when we can definitively say that a cure has been found. Unfortunately, that day has not come yet.

Needs to be viewed in light of other advances
 

For her2+ve, I think that this evidence needs to be weighed against other very recent advances. CMF is known not to be very effective against her2+ve breast cancer compared to anthracyclines, let alone antracycline followed by taxane, and even those are nothing compared to the recent advances in herceptin-based chemo. This one really is something the oncologists need to decide on.

Interim Analysis of Phase 3 Study Shows Taxotere (docetaxel)-Based Regimens with Herc
 

A recent release.

RB

http://www.docguide.com/news/content...2570D9005F0ADD

ABSTRACT


Interim Analysis of Phase 3 Study Shows Taxotere (docetaxel)-Based Regimens with Herceptin (trastuzumab) Significantly Improved Disease-Free Survival in Women with Early-Stage HER2-Positive Breast Cancer

Results from the BCIRG 006 study also show that a novel non-anthracycline-based regimen ("TCH") with Taxotere(R) (docetaxel), the platinum salt carboplatin and Herceptin(R) (trastuzumab) reduces the risk of recurrence without increasing cardiotoxicity in patients with early stage HER2-positive breast cancer

SAN ANTONIO, TX -- December 16, 2005 -- The Breast Cancer International Research Group (BCIRG) and the sanofi-aventis Group today announced the results from the first interim efficacy and updated safety analyses from the BCIRG 006 phase 3 breast cancer study, which show that Herceptin(R) combined with Taxotere(R)-based regimens significantly improved disease free survival for women with early HER2-positive breast cancer.

This data was presented at the 28th annual San Antonio Breast Cancer Symposium (SABCS) in San Antonio, Texas, United States.

In reference to the general advisory of reducing the chemo for early stage cancer patient, there is an important factor of economics. Doctors and medicine suppliers are making tremendous amount of money from the office visits, infusion center visits, blood tests, red blood cell enhancement shots, allergy/desensitizing shots, chemo itself and other services. If you ever got to see the itemized bills, you would be shocked in how they do their mathematics. Therefore, most doctors' offices do not show you the bills although you are entitled to see them. I asked for their bills and was shocked to see how they had the nerve to charge every single item at such an inflated prices. One infusion could easily amounted to several thousand dollars. Therefore, in spite of the low percentage of efficacy from the chemo treatment, many oncs are advocating the chemo as a standard course of action. I don't want to say this is their primary objective, but the big dollars certainly play a role in the decision making process for some of them. I don't want to say this is necessarily their mission and I sincerely believe they do have their patients health as their primary concern. On the other hand, reducing chemo treatment will certain mean a substantial drop in their earning. All professionals still need to have adequate income to justify their existence. I know many of you will be very critical to my remarks above but this is a very rarely discussed topic, particularly our lives are at stake.

Just some food for thoughts.

Ann

Questions
 

Are oncologists attached to a hospital or clinical unit in any way bound to overall policy decisions of the establishement?

Who sets such overall policies, and to what extent does impact on profitabilty come into consideration for different treatment options with similar outcomes, or lack of certainties?

To what extent are treatment policies prescribed by the state / advisory boards / the "state"? Are these bodies sufficiently responsive to change?

To what extent is performance measured by the number of cancer patients given chemo ( I think I rememer hearing that UK public sector measurements include this as a factor - does anybody know?)

To what extent is demand patient driven because a treatment exists and alernatives are limited not withstanding relatively low reponse rates overall (eg. 15% reported above).

Are there polices in cancer treatment that might equate to the claimed impact of a "drill and fill" payment based system in public dentistry?

Would treatment polcies be different if greater rewards were given for patient consultation and education, testing of progression markers, prreventative testing to allow risk warning etc., to help make up for income losses at the coal face, and result in better or worse outcomes at a patient level?

Huge questions upon which I am in no way sufficiently knowledgable to pass any comment on.

RB