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Cancer Resources > Cancer News > Cancer News from Reuters > Reuters Cancer News > 2006 > April
Prognosis similar in estrogen positive and negative breast cancer
Last Updated: 2006-04-12 14:39:05 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Because of recent advances in chemotherapy, patients with node-positive estrogen receptor (ER)-negative breast cancer experience survival outcomes that approach those of patients with ER-positive tumors treated with tamoxifen, investigators report. Moreover, ER-positive tumors are less likely to benefit from intensive chemotherapy than their ER-negative counterparts.
According to their report in the Journal of the American Medical Association for April 12, the positive response to tamoxifen and aromatase inhibitors has previously led to better prognoses among ER-positive women than women with ER-negative cancer, Dr. Donald A. Berry from the University of Texas MD Anderson Cancer Center in Houston and colleagues note.
To compare the differences in benefits from adjuvant chemotherapy achieved by patients with ER-negative tumors and ER-positive tumors treated with tamoxifen. The team evaluated outcomes from three sequential randomized trials.
The first trial, conducted between 1985 and 1991, compared three regimens of cyclophosphamide, doxorubicin and fluorouracil (CAF). The study carried out between 1994 and 1997 compared three doses of doxorubicin concurrent with cyclophosphamide, with or without subsequent paclitaxel. The third trial, which took place between 1997 and 1999, evaluated the differences between concurrent and sequential doxorubicin and cyclophosphamide, plus paclitaxel, administered as 2-week or 3-week cycles.
The most recent regimen given every 2 weeks reduced the risk of death over 5 years by 55% among ER-negative patients and by 23% among ER-positive patients, compared with the low-dose CAF trial. The corresponding absolute difference in 5-year survival was 16.7% and 4.0%.
The patterns of risk were similar across the three trials, with ER-negative patients at higher risk of recurrence or death during the first 2 to 3 years after treatment than ER-positive patients. However, after 3 to 5 years, the risk of recurrence was the same in both groups, 2% to 4%.
Dr. Berry and his associates point out that "the benefits of intensive and extensive chemotherapy for unselected patients who have ER-positive disease treated with tamoxifen are modest at best."
In contrast, they maintain that "with advances in chemotherapy, patients with ER-negative tumors have had sequentially improved outcomes and their prognoses now approach those of optimally treated patients with ER-positive disease."
JAMA 2006;1658-1667.
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