Interview
with Neil Love, MD from Breast Cancer Update for Medical Oncologists,
Program 3 2000
Play
Audio Below:
It
used to be convenient to dichotomize or trichotomize node-positive
breast cancer into subsets based on the number of positive nodes
– recognizing that these are artificial cut points – to
look at the 0 to 3 node group as being prognostically different
than the 4 to 9 node group compared to the 10 or more node group
and perhaps selecting adjuvant chemotherapy based on those specific
risk factors. I think the distinction’s becoming more blurred,
partly because we presently lack at any prospective randomized data
showing an advantage for high-dose stem cell supported therapy over
conventional therapy. With the unfortunate recent revelation of
fraudulent data from South Africa we’re really back to square
one, so I don’t think we can carve out the 10 or more node
subset as being a distinct group from patients with fewer positive
nodes in terms of treatment selection.
I
think there are data to suggest that for patients with four or more
nodes, one probably should use anthracycline-based treatment and
that has been a standard of ours at Memorial for many years where
we used the classic Bonadona regimen of sequential adriamycin and
CMF. But I think now, more importantly, with the results of the
CALGB 9344 trial showing a survival benefit for the addition of
Taxol after AC, we’ve really blurred the distinction in terms
of numbers of positive nodes since that benefit has been seen in
all subsets and we’ll need longer follow-up to see how big
that benefit is but, for the moment, things have become unexpectedly
simple. Patients with node-positive breast cancer will generally
receive AC x 4 followed by Taxol x 4 if they are seen by myself
or my colleagues at Memorial.
