Patient benefits from new treatment options and schedules for breast cancer

Adjuvant chemotherapy is of proven survival benefit for patients with early breast cancer, but trials of new adjuvant therapies take many years to conduct and evaluate. In addition, adjuvant chemotherapy is given "blind," with no prior knowledge of the sensitivity of a patient's tumor to the agents being used. Primary chemotherapy is an innovative approach in which chemotherapy is given as first-line treatment, before surgery. This approach was developed for tumor reduction in inoperable locally advanced breast cancer, and the results obtained in several studies suggested that primary chemotherapy with adjuvant surgery could be an effective alternative to the conventional approach of primary surgery with adjuvant chemotherapy. Several combination regimens have proved successful as primary chemotherapy, with response rates of 69% to 78%, including 12% to 30% complete remissions. The use of infusional 5-fluorouracil, in combination with bolus injections of epirubicin and cisplatin (infusional ECF), as primary chemotherapy in women with metastatic or locally advanced breast cancer has been pioneered by The Royal Marsden NHS Trust in the United Kingdom. Infusional ECF has shown a response rate of 98%, with 66% complete remissions, in a trial involving 50 women with large operable breast tumors. Infusional ECF is now being compared with conventional doxorubicin/cyclophosphamide chemotherapy in a multicenter trial. Administering chemotherapy before surgery also allows the drug sensitivity of the tumor to be assessed at the time of treatment. Techniques for testing the chemosensitivity of tumors in vivo and adjusting the chemotherapy in line with initial results are being investigated. In this way, primary chemotherapy may offer an effective approach to testing new therapies as front-line treatments.