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You are here: Home: BCU 3|2001: Editor's note
Editor
’s Note
FROM CONTROVERSY
TO CONSENSUS
"I believe
that you can cure some patients with metastatic breast cancer.
It's a very small percentage, but you can do it."
—Gabriel
Hortobagyi, MD
In addition to
this surprising assertion by MD Anderson's research icon, the current
issue of Breast Cancer Update contains a number of other perspectives
that would engender considerable debate. The table below lists a
few more provocative comments in our current issue, but I can easily
recall other interviews where equally credible oncology leaders
verbalized very different viewpoints. Perhaps the most compelling
concept verbalized by Dr Hortobagyi is his belief that in spite
of remarkable recent reductions in breast cancer mortality, many
patients are dying because of suboptimal therapy. Narrowing the
gap between research advances and clinical care is the essence of
Breast Cancer Update, and over the years, I have witnessed many
instances where nationally and internationally respected investigators
expressed diametrically opposed viewpoints.
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COMMENTS
IN THIS ISSUE OF BREAST CANCER UPDATE*
- Adjuvant
FAC for six cycles is superior to four cycles of AC.
- AC
is less likely to cause ovarian failure than CMF.
- Anastrozole
is a more selective aromatase inhibitor than letrozole.
- Both
tamoxifen and aromatase inhibitors downgrade breast cancers
in vivo.
- Tamoxifen
is not associated with depression or weight gain in placebo-controlled
trials.
- Taxanes
have a similar antitumor effect regardless of ER status.
- The
effect of pregnancy on recurrence in a breast cancer survivor
is unknown.
- Menopausal
hormone replacement increases breast cancer risk by about
35% during therapy.
*(1)G Hortobagyi (2)J Petrek (3)A Buzdar (4)JM Dixon (5)P
Ganz
(6)A Buzdar (7)J Petrek (8)P Ganz
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Some of these
controversies haunt me. For example, in an interview for this series
during the 1990 NIH Consensus Conference, both Dr Helen Stewart
and Dr Michael Baum — who were presenting early data from the
United Kingdom and Scotland — insisted that the value of adjuvant
tamoxifen was equivalent in pre-and postmenopausal women.
At that time, most U.S.researchers were dubious about benefits in
younger women, and it was not until the international overview in
1995 that it became clear that Drs Stewart and Baum were absolutely
on target. I sadly calculated that in the five years between that
memorable Bethesda interview and Richard Peto's Oxford presentation
demonstrating a 50% reduction in recurrence rate in tamoxifen-treated
patients regardless of age, perhaps 200,000 premenopausal women
in the United States alone had been diagnosed with breast cancer,
and a minority had been offered tamoxifen.
The receptor-positive patients who relapsed during that window in
technology transfer have now been replaced by a new generation of
patients who may die unnecessarily if research advances do not reach
the community front lines expeditiously. As always, the enclosed
program and our website — BreastCancerUpdate.com — not
only capture oncology leader opinion, but also include a plethora
of information on current clinical trials. In addition to helping
move the state-of-the-art forward, participation in research allows
oncologists to integrate their nonprotocol therapy into the cutting
edge of cancer care.
Ten or 15 years from now we will look back on today's statements
of research leaders and realize that some were prophetic,while others
were off target. In the interim, patients will receive treatment
based on our best assessment as to what the current generation of
clinical trials will eventually demonstrate.
—Neil
Love, MD
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