This Article Full Text Full Text (PDF) eLetters: Submit a response to this article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints/Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Aapro, M. S. Search for Related Content PubMed PubMed Citation Articles by Aapro, M. S.

Adjuvant Therapy of Primary Breast Cancer: A Review of Key Findings from the 7th International Conference, St. Gallen, February 2001

Correspondence: Matti S. Aapro, M.D., Clinique de Genolier, 1 Route de Muids, Genolier CH-1272 Switzerland. Telephone: 41-22-366-9134; Fax: 41-22-366-9131; e-mail: aapro{at}cdg.ch

Breast cancer research has developed at a rapid pace over the last decades. Recent discoveries promise to provide individualized treatment options, increased long-term survival for women with breast cancer, and the possibility of moving toward curative intent in the treatment of advanced breast cancer. Age, race, tumor size, histological tumor type, axillary nodal status, standardized pathological grade, and hormone-receptor status are accepted as established prognostic and/or predictive factors for selection of systemic adjuvant treatment of breast cancer. The role of other promising new factors, such as p53 mutations, HER-2 status, plasminogen activator system, histological evidence of vascular invasion, and quantitative parameters of angiogenesis will be determined in ongoing prospective studies. Currently, 5 years' treatment with adjuvant tamoxifen in women with hormone-positive receptor status, is regarded as the optimal duration of treatment. Long-term follow-up on the randomized trials will determine the added benefit of treatment beyond 5 years. Ovarian ablation has shown a reduction in recurrence and death, and the exact role and extent of adjuvant chemotherapy in premenopausal women with hormone-responsive tumors is under discussion. Combination hormonal and chemo-hormonal therapies are also being evaluated. There are no convincing data on the survival impact of tamoxifen as a preventative therapy for breast cancer: longer-term follow-up is required, and the planned meta-analyses in 2005 should help shed light on this issue. Statistically significant benefits have been observed with adjuvant chemotherapy (particularly with anthracycline-containing regimens in premenopausal women) versus no adjuvant chemotherapy. The optimal length of adjuvant anthracycline/cyclophosphamide (AC) regimens needs further evaluation as do randomized comparisons of AC to cyclophosphamide/ doxorubicin/5-fluorouracil (5-FU) and cyclophosphamide/epirubicin/5-FU. Although taxanes promise to provide an additive benefit to adjuvant chemotherapy regimens, the Cancer and Leukemia Group B 9344 and the National Surgical Adjuvant Breast and Bowel Project B-28 studies evaluating paclitaxel in the adjuvant setting have not yet demonstrated statistically significant benefits on disease-free survival and overall survival. In the year 2000, all adjuvant therapy studies conducted by the Co-operative Groups in both node-negative and node-positive disease involve a taxane. High-dose chemotherapy evaluations are still ongoing. The numerous prospective adjuvant therapy trials (hormonal; selective estrogen-receptor modulators; aromatase inhibitors; chemotherapy, involving anthracyclines/taxanes/platinum/trastuzumab; biological factors; elderly women (>70 years); high-risk patients; radiotherapy in 1-3 positive lymph nodes), and neoadjuvant studies might further define the chances to enhance cure rates in the treatment of primary breast cancer.

Key Words. Adjuvant chemotherapy • Neoadjuvant chemotherapy • Primary breast cancer • Consensus • St. Gallen

This article has been cited by other articles:

				V Malamou-Mitsi, H Gogas, U Dafni, A Bourli, T Fillipidis, M Sotiropoulou, D Vlachodimitropoulos, S Papadopoulos, O Tzaida, G Kafiri, et al. Evaluation of the prognostic and predictive value of p53 and Bcl-2 in breast cancer patients participating in a randomized study with dose-dense sequential adjuvant chemotherapy Ann. Onc., October 1, 2006; 17(10): 1504 - 1511. [Abstract] [Full Text] [PDF]

				D. Cameron, R. Bell, M. Aapro, and C. Zielinski What Are the Current Standards of Care and Recent Developments in the Management of Breast Cancer? Oncologist, September 1, 2006; 11(suppl_1): 1 - 3. [Full Text] [PDF]

				X. Li, J. Zhang, H. Gao, E. Vieth, K.-H. Bae, Y.-P. Zhang, S.-J. Lee, S. Raikwar, T. A. Gardner, G. D. Hutchins, et al. Transcriptional targeting modalities in breast cancer gene therapy using adenovirus vectors controlled by {alpha}-lactalbumin promoter Mol. Cancer Ther., December 1, 2005; 4(12): 1850 - 1859. [Abstract] [Full Text] [PDF]

				E. P. Mamounas Can We Approach Zero Relapse in Breast Cancer? Oncologist, October 1, 2005; 10(suppl_2): 9 - 17. [Abstract] [Full Text] [PDF]

				A. DeMichele, R. Aplenc, J. Botbyl, T. Colligan, L. Wray, M. Klein-Cabral, A. Foulkes, P. Gimotty, J. Glick, B. Weber, et al. Drug-Metabolizing Enzyme Polymorphisms Predict Clinical Outcome in a Node-Positive Breast Cancer Cohort J. Clin. Oncol., August 20, 2005; 23(24): 5552 - 5559. [Abstract] [Full Text] [PDF]

				J. C. Chang, E. C. Wooten, A. Tsimelzon, S. G. Hilsenbeck, M. C. Gutierrez, Y.-L. Tham, M. Kalidas, R. Elledge, S. Mohsin, C. K. Osborne, et al. Patterns of Resistance and Incomplete Response to Docetaxel by Gene Expression Profiling in Breast Cancer Patients J. Clin. Oncol., February 20, 2005; 23(6): 1169 - 1177. [Abstract] [Full Text] [PDF]

				P J Westenend, C J C Meurs, and R A M Damhuis Tumour size and vascular invasion predict distant metastasis in stage I breast cancer. Grade distinguishes early and late metastasis J. Clin. Pathol., February 1, 2005; 58(2): 196 - 201. [Abstract] [Full Text] [PDF]

				J. Sun, J. Ohkanda, D. Coppola, H. Yin, M. Kothare, B. Busciglio, A. D. Hamilton, and S. M. Sebti Geranylgeranyltransferase I Inhibitor GGTI-2154 Induces Breast Carcinoma Apoptosis and Tumor Regression in H-Ras Transgenic Mice Cancer Res., December 15, 2003; 63(24): 8922 - 8929. [Abstract] [Full Text] [PDF]

				D. Miles, G. von Minckwitz, and A. D. Seidman Combination Versus Sequential Single-Agent Therapy in Metastatic Breast Cancer Oncologist, December 1, 2002; 7(90006): 13 - 19. [Abstract] [Full Text] [PDF]