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. 1997;76(8):1099–1105. doi: 10.1038/bjc.1997.514

Primary systemic therapy for operable breast cancer--10-year survival data after chemotherapy and hormone therapy.

D A Cameron 1, E D Anderson 1, P Levack 1, R A Hawkins 1, T J Anderson 1, R C Leonard 1, A P Forrest 1, U Chetty 1
PMCID: PMC2228097  PMID: 9376273

Abstract

Between 1984 and 1990, 94 women presenting to the Edinburgh Breast Unit with operable breast cancer of 4 cm or greater in diameter (T2, T3, N0, N1, M0) were given preoperative systemic therapy. Initially, all women received hormone therapy, with CHOP (cyclophosphamide 1 g m(-2), doxorubicin 50 mg m(-2), vincristine 1.4 mg m(-2) to a maximum of 2 mg and prednisolone 40 mg per day orally for 5 days) chemotherapy being administered to those who failed to respond by 3 months. After April 1987, first-line hormone therapy was only offered to women with oestrogen receptor (ER)-moderate/-rich (> 20 fmol mg(-1) protein) tumours, and CHOP was reserved for those women whose tumours failed to respond to hormone therapy and for those with ER-negative/-poor tumours. Response data have been published previously (Anderson et al, 1991). After a median follow-up of 7.5 years, there is no difference in survival between those women given initial hormone therapy and those given chemotherapy, with neither group having yet reached its median survival. The two key factors that predicted for a poor survival were the number of involved axillary nodes after preoperative systemic therapy (P < 0.00001) and a lack of response to preoperative therapy (P < 0.05). These data suggest that many women with ER-moderate/-rich tumours will have a good prognosis after preoperative hormone therapy alone. However, it is possible to identify, by their post-systemic therapy axillary node status, a group of women who still have an appalling prognosis after preoperative chemotherapy or hormone therapy.

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Selected References

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  1. Anderson E. D., Forrest A. P., Hawkins R. A., Anderson T. J., Leonard R. C., Chetty U. Primary systemic therapy for operable breast cancer. Br J Cancer. 1991 Apr;63(4):561–566. doi: 10.1038/bjc.1991.131. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Anderson E. D., Forrest A. P., Levack P. A., Chetty U., Hawkins R. A. Response to endocrine manipulation and oestrogen receptor concentration in large operable primary breast cancer. Br J Cancer. 1989 Aug;60(2):223–226. doi: 10.1038/bjc.1989.256. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bonadonna G., Valagussa P., Brambilla C., Ferrari L. Preoperative chemotherapy in operable breast cancer. Lancet. 1993 Jun 5;341(8858):1485–1485. doi: 10.1016/0140-6736(93)90933-8. [DOI] [PubMed] [Google Scholar]
  4. Bonadonna G., Veronesi U., Brambilla C., Ferrari L., Luini A., Greco M., Bartoli C., Coopmans de Yoldi G., Zucali R., Rilke F. Primary chemotherapy to avoid mastectomy in tumors with diameters of three centimeters or more. J Natl Cancer Inst. 1990 Oct 3;82(19):1539–1545. doi: 10.1093/jnci/82.19.1539. [DOI] [PubMed] [Google Scholar]
  5. Botti C., Vici P., Lopez M., Scinto A. F., Cognetti F., Cavaliere R. Prognostic value of lymph node metastases after neoadjuvant chemotherapy for large-sized operable carcinoma of the breast. J Am Coll Surg. 1995 Sep;181(3):202–208. [PubMed] [Google Scholar]
  6. Bélembaogo E., Feillel V., Chollet P., Curé H., Verrelle P., Kwiatkowski F., Achard J. L., Le Bouëdec G., Chassagne J., Bignon Y. J. Neoadjuvant chemotherapy in 126 operable breast cancers. Eur J Cancer. 1992;28A(4-5):896–900. doi: 10.1016/0959-8049(92)90145-r. [DOI] [PubMed] [Google Scholar]
  7. Calais G., Descamps P., Chapet S., Turgeon V., Reynaud-Bougnoux A., Lemarié E., Fignon A., Body G., Bougnoux P., Lansac J. Primary chemotherapy and radiosurgical breast-conserving treatment for patients with locally advanced operable breast cancers. Int J Radiat Oncol Biol Phys. 1993 Apr 30;26(1):37–42. doi: 10.1016/0360-3016(93)90170-z. [DOI] [PubMed] [Google Scholar]
  8. Cheung C. W., Johnson A. E. Carcinoma of the breast: measurement and the management of treatment. I. The value of the data. Br J Radiol. 1991 Jan;64(757):29–36. doi: 10.1259/0007-1285-64-757-29. [DOI] [PubMed] [Google Scholar]
  9. Clarke R. B., Laidlaw I. J., Jones L. J., Howell A., Anderson E. Effect of tamoxifen on Ki67 labelling index in human breast tumours and its relationship to oestrogen and progesterone receptor status. Br J Cancer. 1993 Mar;67(3):606–611. doi: 10.1038/bjc.1993.111. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Fisher B., Slack N. H., Bross I. D. Cancer of the breast: size of neoplasm and prognosis. Cancer. 1969 Nov;24(5):1071–1080. doi: 10.1002/1097-0142(196911)24:5<1071::aid-cncr2820240533>3.0.co;2-h. [DOI] [PubMed] [Google Scholar]
  11. Forouhi P., Dixon J. M., Leonard R. C., Chetty U. Prospective randomized study of surgical morbidity following primary systemic therapy for breast cancer. Br J Surg. 1995 Jan;82(1):79–82. doi: 10.1002/bjs.1800820127. [DOI] [PubMed] [Google Scholar]
  12. Forrest A. P., Levack P. A., Chetty U., Hawkins R. A., Miller W. R., Smyth J. F., Anderson T. J. A human tumour model. Lancet. 1986 Oct 11;2(8511):840–842. doi: 10.1016/s0140-6736(86)92872-2. [DOI] [PubMed] [Google Scholar]
  13. Gardin G., Rosso R., Campora E., Repetto L., Naso C., Canavese G., Catturich A., Corvò R., Guenzi M., Pronzato P. Locally advanced non-metastatic breast cancer: analysis of prognostic factors in 125 patients homogeneously treated with a combined modality approach. Eur J Cancer. 1995;31A(9):1428–1433. doi: 10.1016/0959-8049(95)00199-s. [DOI] [PubMed] [Google Scholar]
  14. Gröhn P., Heinonen E., Klefström P., Tarkkanen J. Adjuvant postoperative radiotherapy, chemotherapy, and immunotherapy in stage III breast cancer. Cancer. 1984 Aug 15;54(4):670–674. doi: 10.1002/1097-0142(1984)54:4<670::aid-cncr2820540414>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]
  15. Hawkins R. A., Tesdale A. L., Anderson E. D., Levack P. A., Chetty U., Forrest A. P. Does the oestrogen receptor concentration of a breast cancer change during systemic therapy? Br J Cancer. 1990 Jun;61(6):877–880. doi: 10.1038/bjc.1990.196. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Horobin J. M., Preece P. E., Dewar J. A., Wood R. A., Cuschieri A. Long-term follow-up of elderly patients with locoregional breast cancer treated with tamoxifen only. Br J Surg. 1991 Feb;78(2):213–217. doi: 10.1002/bjs.1800780228. [DOI] [PubMed] [Google Scholar]
  17. Jacquillat C., Weil M., Baillet F., Borel C., Auclerc G., de Maublanc M. A., Housset M., Forget G., Thill L., Soubrane C. Results of neoadjuvant chemotherapy and radiation therapy in the breast-conserving treatment of 250 patients with all stages of infiltrative breast cancer. Cancer. 1990 Jul 1;66(1):119–129. doi: 10.1002/1097-0142(19900701)66:1<119::aid-cncr2820660122>3.0.co;2-3. [DOI] [PubMed] [Google Scholar]
  18. Keen J. C., Miller E. P., Bellamy C., Dixon J. M., Miller W. R. P-glycoprotein and resistance to tamoxifen. Lancet. 1994 Apr 23;343(8904):1047–1048. doi: 10.1016/s0140-6736(94)90169-4. [DOI] [PubMed] [Google Scholar]
  19. Mauriac L., Durand M., Avril A., Dilhuydy J. M. Effects of primary chemotherapy in conservative treatment of breast cancer patients with operable tumors larger than 3 cm. Results of a randomized trial in a single centre. Ann Oncol. 1991 May;2(5):347–354. doi: 10.1093/oxfordjournals.annonc.a057953. [DOI] [PubMed] [Google Scholar]
  20. Morrison J. M., Howell A., Kelly K. A., Grieve R. J., Monypenny I. J., Walker R. A., Waterhouse J. A. West Midlands Oncology Association trials of adjuvant chemotherapy in operable breast cancer: results after a median follow-up of 7 years. I. Patients with involved axillary lymph nodes. Br J Cancer. 1989 Dec;60(6):911–918. doi: 10.1038/bjc.1989.389. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Pichon M. F., Broet P., Magdelenat H., Delarue J. C., Spyratos F., Basuyau J. P., Saez S., Rallet A., Courriere P., Millon R. Prognostic value of steroid receptors after long-term follow-up of 2257 operable breast cancers. Br J Cancer. 1996 Jun;73(12):1545–1551. doi: 10.1038/bjc.1996.291. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Remvikos Y., Mosseri V., Zajdela A., Fourquet A., Durand J. C., Pouillart P., Magdelénat H. Prognostic value of the S-phase fraction of breast cancers treated by primary radiotherapy or neoadjuvant chemotherapy. Ann N Y Acad Sci. 1993 Nov 30;698:193–203. doi: 10.1111/j.1749-6632.1993.tb17209.x. [DOI] [PubMed] [Google Scholar]
  23. Scholl S. M., Fourquet A., Asselain B., Pierga J. Y., Vilcoq J. R., Durand J. C., Dorval T., Palangié T., Jouve M., Beuzeboc P. Neoadjuvant versus adjuvant chemotherapy in premenopausal patients with tumours considered too large for breast conserving surgery: preliminary results of a randomised trial: S6. Eur J Cancer. 1994;30A(5):645–652. doi: 10.1016/0959-8049(94)90537-1. [DOI] [PubMed] [Google Scholar]
  24. Scholl S. M., Pierga J. Y., Asselain B., Beuzeboc P., Dorval T., Garcia-Giralt E., Jouve M., Palangié T., Remvikos Y., Durand J. C. Breast tumour response to primary chemotherapy predicts local and distant control as well as survival. Eur J Cancer. 1995 Nov;31A(12):1969–1975. doi: 10.1016/0959-8049(95)00454-8. [DOI] [PubMed] [Google Scholar]
  25. Semiglazov V. F., Topuzov E. E., Bavli J. L., Moiseyenko V. M., Ivanova O. A., Seleznev I. K., Orlov A. A., Barash N. Y., Golubeva O. M., Chepic O. F. Primary (neoadjuvant) chemotherapy and radiotherapy compared with primary radiotherapy alone in stage IIb-IIIa breast cancer. Ann Oncol. 1994 Sep;5(7):591–595. doi: 10.1093/oxfordjournals.annonc.a058929. [DOI] [PubMed] [Google Scholar]
  26. Swenerton K. D., Legha S. S., Smith T., Hortobagyi G. N., Gehan E. A., Yap H. Y., Gutterman J. U., Blumenschein G. R. Prognostic factors in metastatic breast cancer treated with combination chemotherapy. Cancer Res. 1979 May;39(5):1552–1562. [PubMed] [Google Scholar]
  27. Tormey D. C., Gray R., Abeloff M. D., Roseman D. L., Gilchrist K. W., Barylak E. J., Stott P., Falkson G. Adjuvant therapy with a doxorubicin regimen and long-term tamoxifen in premenopausal breast cancer patients: an Eastern Cooperative Oncology Group trial. J Clin Oncol. 1992 Dec;10(12):1848–1856. doi: 10.1200/JCO.1992.10.12.1848. [DOI] [PubMed] [Google Scholar]

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