Opportunities in clinical trials. Adjuvant breast cancer

Breast cancer is the most common cancer in women in the US, with approximately two-thirds of patients presenting with tumors confined to the breast alone or breast and ipsilateral axillary lymph nodes. Although all of these women can be rendered free of detectable breast cancer by local therapeutic modalities, many will experience recurrences regionally or at distant sites. Nearly all patients who have distant recurrences will subsequently die of breast cancer. Although metastatic breast cancer responds to a variety of hormonal and chemotherapeutic interventions, it is rare that such therapy is curvative. Hence, there has been great interest in studying adjuvant systemic therapies. There is now a long clinical trial experience with adjuvant therapy in breast cancer that provides an extensive background for implementing recent advances in molecular and cellular biology in the clinical setting. Predictably, these laboratory-clinical correlations will provide important leads for future generations of randomized adjuvant trials, both by helping to target new therapies for particular subsets of patients and by identifying prognostic groups. In this report, current efforts in adjuvant therapy trials and laboratory-clinical correlations being conducted in conjunction with those trials are described.