What can be expected from the next generation of adjuvant breast cancer treatment?

At present, the adjuvant therapy of breast cancer is the only treatment that offers the prospect of cure. However, recent meta-analysis has shown that although they are statistically significant, the benefits that accompany existing adjuvant chemotherapy or endocrine therapy are modest. Hence, there is a pressing need to evaluate the contribution of active new agents such as the taxanes in the adjuvant setting. A further challenge is to integrate entirely new treatment strategies targeting signal transduction, apoptosis, and angiogenesis with existing treatments. Progress also is being made in the identification of molecular markers, such as overexpression of the c-erbB2 receptor, which may influence the selection of adjuvant therapy to be given to those patients at greatest risk from their breast cancer. Success in all these areas requires rigorously conducted clinical trials. These will be conducted efficiently and rapidly only if there is good collaboration between investigators, such as is now being expected from the recently created Breast International Group.