Practice ABC of breast diseases

Medical treatment of early breast cancer. III: chemotherapy

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7534.161 (Published 19 January 2006) Cite this as: BMJ 2006;332:161
  1. Ian Smith, professor of cancer medicine,
  2. Susan Chua, medical oncologist
  1. Royal Marsden Hospital, London
  2. Melbourne, Australia

    Adjuvant chemotherapy is of significant survival benefit in women aged < 70 years with moderate to high risk breast cancer. The benefits seem to be greater in younger women. This is mainly because of biological factors, including a higher incidence of grade III and hormone receptor negative cancers. Ovarian failure induced by chemotherapy is also likely to be a factor in women with oestrogen receptor positive tumours. Chemotherapy benefit is also seen in high risk women aged > 50 years, but for many of these women endocrine therapy alone may be just as effective, except when the tumour is grade III, tests positive for human epidermal growth factor receptor 2 (HER2), or there is multiple node involvement. Risk benefit considerations are always important here because of toxicity, and consensus criteria have been defined to aid in selecting patients for treatment.

    Disease free (top) and overall (bottom) survival in a randomised study of adjuvant docetaxel, doxorubicin, and cyclophosphamide (TAC) compared with fluorouracil, doxorubicin, and cyclophosphamide (FAC). Adapted from Martin M. N Engl J Med 2005;352: 2302-13

    Which chemotherapy regimen?

    Evidence shows that anthracycline regimens with doxorubicin or epirubicin achieve a significant further survival improvement (around 4-5%) over treatment with cyclophosphamide, methotrexate, and fluorouracil (CMF), and these are increasingly used as standard. In the United Kingdom, a sequential combination of anthracyclines followed by CMF is widely used …

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