NIH Panel Backs Combination Of Breast Cancer Drugs
AP 4nov00

Many women should consider taking a combination of chemotherapy drugs after surgery for localized breast cancer because the additional treatment improves long-term survival, a panel of experts said yesterday.

Three to six months of treatment with two or more chemotherapy drugs is optimal, and can benefit even women whose cancer has not spread to their lymph nodes, concluded the panel, convened by the National Institutes of Health.

The main treatment for localized breast cancer is surgery to remove either the tumor alone or the cancerous breast. But many women also undergo post-surgical treatment, called "adjuvant therapy," that helps kill remaining cancer cells floating in the body.

The NIH convened breast cancer experts for a three-day conference to hear the latest research and determine which adjuvant therapies are best proven to work in different circumstances.

Among the findings:

• Adjuvant therapy substantially improves long-term survival in premenopausal and postmenopausal women to age 70, and in women with both cancer-free and cancer-positive lymph nodes. The biggest benefit occurs when the tumor is larger than 1 centimeter.
• Using at least two chemotherapy drugs together, for three to six months, is better than one drug. Combinations that include at least one anthracycline, a type of chemotherapy drug, work best. Anthracyclines can cause serious cardiac toxicity, but studies show that is a minimal risk if the patient does not have significant preexisting heart disease, the panel added.
• Drugs in the Taxol family are good treatments for metastatic, or spreading, breast cancer. But there is no proof yet that Taxol and related drugs are a good adjuvant therapy for localized breast cancer, and thus they shouldn't be used outside clinical trials.
• More study is needed before women select a specific chemotherapy based on newly discovered genetic risk factors.
• Most women who have "hormone receptors" on their cancer cells--a risk factor that signals estrogen could fuel the cancer's growth--should receive hormone therapy. The standard treatment is five years of tamoxifen; it can be added to chemotherapy if needed. Alternative drugs such as raloxifene are not yet proven. Women who do not have hormone receptors should not get tamoxifen.
• High-dose chemotherapy followed by a bone-marrow transplant is not a proven therapy and should be restricted to clinical trials.
• Radiation is necessary for all women who undergo a lumpectomy, where just the tumor is removed. But radiation can help some mastectomy patients, too--those with very large primary tumors or when cancer has spread to four or more lymph nodes.

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