chemo vs agonist

[AlaskaAngel]

The question of the usefulness of Adriamycin has been raised recently. In addition, consider this:

http://www.cancerpage.com/news/article.asp?id=11056


"Exploratory analysis showed significantly better 5-year overall survival rates with leuprorelin (81.0%) compared with CMF (71.9%) and a trend for higher breast cancer-related mortality in the CMF group."

[Hopeful]

Alaska Angel,

One aspect of chemotherapy use which I believe to be inadequately addressed is its usefulness in the hormone positive population. Data from the Early Breast Cancer Trialists Collaborative Group clearly shows that hormone positive bc is a disease with slow but consistent recurrence rates out to 20 and 25 years. I think the onconlogy community relies on chemo as a panacea that eliminates recurrence risk for everyone, when that is just not so. Because of this heavy reliance on this particular form of treatment, I think the endocrine aspects of the disease are not being investigagted or treated in a manner that optomizes treatment outcomes for this group. There is a serious need to question the overuse of cytotoxic drugs for bc treatment and start focusing on what drives different forms of the disease. With the attitude that "chemo cures everything," a lot of necessary research is not getting done. Just MO.

Hopeful

[TSund]

Questions:

1) I understand that Herceptin has a better success rate when combined with chemo. Is this true of hormonally positive cancers also? Is there any study of Heceptin plus hormal drugs vs Herceptin plus chemo?

2) What percentage of the success of chemo has to do with the chemo-pause and what with the actual "cancer killing" properties?

3) Ruth is 100%+ ER and 95%+ PR and yet had the first treatment had a good effect shrinking tumors. I'm guessing that is not the hormonal factor, as usually women have one more cycle before going into chemopause. Is chemo more effective for HER2+/ER+ than ER+ without the HER2 factor?


TRS

[TSund]

PS leuprolin (sp?) is a drug I've not heard of. Is this comparable to the drugs shutting down the ovaries or the AI drugs?

THX!

[Hopeful]

T. Sund,

I am not a medical expert, but I have done a lot of reading since my dx a year ago, and, strictly IMO, here are my thoughts in response to your questions:

1. There has been no study to date comparing Herceptin + chemo to Herceptin + homonal therapy. The TaNDEM study conducted by Roche demonstrated that AI's + Herceptin doubled the time to progression of postmenopausal metastatic bc patients over AI's alone: http://www.medicalnewstoday.com/medi...=69898&nfid=al. Herceptin has been demonstrated to improve results both when administered with chemo http://content.nejm.org/cgi/content/full/353/16/1673 AND following chemo: http://content.nejm.org/cgi/content/full/353/16/1659. There is evidence that some clinicians are offering Herceptin without chemo for some incidences of early stage bc. It is known that Herceptin is active in the body without chemo; however, too little is know about its actual mechanism of action on cancer cells to determine how it is efficacious against it.

2. In a radonmized trial, complete hormonal blockade versus epirubicin-based chemotherapy in premenopausal, one-to-three node positive, hormone positive bc patients was demonstrated to be equivalent treatment: http://annonc.oxfordjournals.org/cgi...ract/17/8/1221.

3. The efficacy of Herceptin has not been shown to depend on hormonal status. As with other drugs, there are classes of patients who respond better to the drug than others. Researchers are currently attempting to identify this patient group, to be able to accurately prescribe Herceptin only to those who will likely respond to it. Unfortunately, Her2+ status alone is not a good enough marker for this.

4. If you are interested in reviewing the findings of the Early Breast Cancer Trialists Collaborative Group on the natural history of ER+ vs. ER- bc, with or without chemo, hormonal therapy or both, the link to their site where you can download the provisional pdf is here:http://www.ctsu.ox.ac.uk/~ebctcg/.

By and large, the bc patient population that derives the least benefit from chemo is hormone postive, node negative, postmenopausal patients.

Hope this helps,

Hopeful

[TSund]

Thank-you Hopeful, for the informative links. Most appreciated!

Terri