Breast Cancer

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March 1st 2001

Breast cancer is a common problem in older women. As the number of medical illnesses increases with age and the life expectancy decreases, the benefits of systemic therapy for women with breast cancer become questionable. All women over age 65 years are at high enough risk of breast cancer to consider the risk/benefit ratio of preventive therapy with tamoxifen (Nolvadex) or participation in the Study of Tamoxifen and Raloxifene (STAR) trial. Adjuvant chemotherapy and hormonal therapies for early breast cancer significantly improve disease-free and overall survival; recommendations for their use are based on risk of tumor recurrence. Use of tamoxifen in the adjuvant setting in women with receptor-positive tumors is a relatively simple decision in light of its favorable toxicity profile. The delivery of adjuvant chemotherapy is a more complicated decision, and the patient’s wishes, estimated life expectancy, presence of comorbid conditions, and estimated benefit from treatment should be considered. The primary goal of the treatment of metastatic breast cancer is palliation. We discuss trials specific to older women and make appropriate treatment recommendations. Unfortunately, there is a paucity of data from clinical trials in women over age 70 years. However, because the clinical trial is the primary scientific mechanism for testing the efficacy of a treatment, every effort should be made to enter older women into treatment protocols. [ONCOLOGY 15(3):280-299, 2001]


CME Content


SAN ANTONIO-In the treatment of early-stage breast cancer, postoperative radiation therapy after sector resection (breast-conserving surgery) reduces recurrences but does not influence survival, according to a Swedish study presented at the 23rd Annual San Antonio Breast Cancer Symposium.

SAN ANTONIO-Adding weekly paclitaxel (Taxol) and carboplatin (Paraplatin) to trastuzumab (Herceptin) improves disease control among women with advanced breast cancer, according to results of an ongoing phase II trial reported by Howard A. Burris III, MD, director of drug development, Sarah Cannon Cancer Center, Nashville.

The 4th National Institutes of Health (NIH) Consensus Conference on Adjuvant Therapy of Breast Cancer, held November 1-3, 2000, concluded that decreasing breast cancer mortality rates in the United States were due, at least in part, to advances made in adjuvant treatment. This fact lends credence to the importance of incremental improvements that have resulted from randomized, controlled clinical trials of adjuvant therapy, and underscores the value of this approach. With 185,000 new diagnoses of breast cancer expected in the United States in 2000, over 100,000 women may be candidates for some form of adjuvant therapy each year.[1]

Numerous trials have shown that the pharmacokinetic interferences of epirubicin (Ellence)/paclitaxel (Taxol) combinations produce less pharmacodynamic effect than doxorubicin/paclitaxel regimens. Paclitaxel is more easily

In a single-center, open, phase II trial, we assessed the toxicity and activity of a triple combination therapy-doxorubicin at 30 mg/m2 (day 1), paclitaxel (Taxol) at 135 mg/m2 (day 2), and gemcitabine (Gemzar) at 2,500 mg/m2

The goal of this activity is to clarify challenging treatment issues of HER2+ breast cancer including incorporation of predictive and prognostic biomarker tests and evidence-based data into practice when determining individualized strategies that improve patient survival and quality of life.

Capecitabine (Xeloda) is the first orally available fluoropyrimidine approved for use in patients with cancer. It was initially approved for use in metastatic breast cancer, but significant data also support its use in the management

WASHINGTON-Inositol hexa-phosphate (IP6) has shown antitumor effects in vitro and in animal models and may be ready for clinical trials in humans, said Ivana Vucenik, PhD, associate professor of medical and research technology, University of Maryland School of Medicine, Baltimore. She presented her study results at the Susan G. Komen Breast Cancer Foundation grants conference "Reaching for the Cure."

BETHESDA, Md-Adjuvant therapy should be offered as an option to node-negative breast cancer patients, even those with tumors smaller than 1 cm, said Bernard Fisher, MD, scientific director of the National Surgical Adjuvant Breast and Bowel Project (NSABP).