Magazine article Drug Topics

NIH Releases Consensus Statement on Breast Cancer

Magazine article Drug Topics

NIH Releases Consensus Statement on Breast Cancer

Article excerpt

In an attempt to make sense of the various treatment approaches available for women with breast cancer, the National Institutes of Health has issued a consensus statement on adjuvant therapies for the malignancy.

"Women with breast cancer have more treatment options and a better chance of surviving their disease than ever before. But, at the same time, making treatment decisions has become a more complex process for them and their physicians due to a growing list of effective options," acknowledged Patricia Eifel, M.D., professor of radiation oncology at M.D. Anderson Cancer Center in Houston. In preparing the recommendations, NIH held a three-day Consensus Development Conference. There, a panel of national and international experts clarified key questions regarding the selection of treatments, quality of life, and new research directions.

Making a general recommendation on the choice of adjuvant therapy, Eifel-a panel member-noted that the "decision should be based on age, tumor size, presence or absence of hormone receptors, presence or absence of cancerous lymph nodes, and other generally accepted factors."

Adjuvant hormonal therapy is recommended by the panel for women whose breast tumors contain estrogen receptors-regardless of age, menopausal status, tumor size, or whether the cancer has spread to nearby lymph nodes. Such treatment has led to substantial reductions in the likelihood of tumor recurrence, second primary breast cancer, and death, persisting for up to 15 years of follow-up. Possible exceptions to hormonal therapy include premenopausal women with tumors less then 10 mm in size who wish to avoid symptoms of estrogen deprivation or elderly women with similarly sized cancers who have a history of venous thromboembolic episodes.

Tamoxifen remains the most commonly used form of hormonal therapy, with five years being the standard duration of treatment. The drug may be combined with combo chemotherapy, particularly in premenopausal women, since such regimens may further reduce the risk of recurrence. The consensus statement makes no recommendations on utilizing raloxifene (Evista, Lilly) or aromatase inhibitors since there are no data to support their use at this time.

The panel recommends combination chemotherapy for pre- and postmenopausal women-- regardless of lymph node involvement or estrogen receptor status. While dreaded by most patients for its infamous list of caustic side effects, chemotherapy has been shown to substantially improve the long-term, relapse-free, and overall survival in both premenopausal and postmenopausal women, up to age 70, with node-positive and node-negative disease. …

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