Breast cancer treatment--current status. 4. Adjuvant therapy

Adjuvant chemotherapy of early breast cancer in premenopausal women has nearly reached the point where it can be said with confidence that the relapse-free survival rate, as well as overall survival rate, is being lengthened, especially when drug combinations are used. In postmenopausal women, however, adjuvant chemotherapy has not consistently improved the relapse-free rate. Some investigators have postulated that postmenopausal patients do not respond as well to chemotherapy as their premenopausal counterparts because they usually receive lower doses. Thus, trials of these drugs at doses that more closely approximate the calculated dose are needed in postmenopausal patients. Recent advances in determination of estrogen and progesterone receptors in breast cancer cells have allowed effective use of adjuvant hormone therapy instead of or in addition to chemotherapy in some patients with early disease. However, further investigation of the role of hormone manipulation in breast cancer is also needed. Adjuvant chemotherapy of advanced breast cancer, however, is only palliative; duration of relapse-free and overall survival is not nearly as long as in early disease. Hormone therapy has been effective as initial treatment in patients with positive estrogen and/or progesterone receptors. Alternative treatments under investigation include use of new anthracycline derivatives, high-dose single agents, and biomodulation with interferon and Staphylococcus aureus protein A. Thus, while advanced breast cancer is not now curable, the wide range of effective agents and promising new approaches to treatment certainly justify some optimism for the future.