Therapy Rethought: Chemo

October 2007 from the Susan G. Komen for the Cure enewsletter:

Taxol® Benefits May Be Limited to HER2-positive and/or ER Negative Breast Cancer

October 11, 2007 - In a study conducted by the Cancer and Leukemia Group B, chemotherapy with paclitaxel (Taxol) was significantly more beneficial in women with HER2-positive and/or ER negative breast cancer following treatment with doxorubicin plus cyclophosphamide than in women whose breast cancers were both ER positive and HER2-negative.

Treatment with many chemotherapy drugs is often accompanied by undesirable side-effects. With Taxol potential side effects include nerve damage. Understanding which patients will benefit from these drugs and not giving them to those who don’t benefit is a goal in current research. Research news such as this is promising because it helps identify the patients who are most likely to benefit from the additional chemotherapy and avoid many side-effects of current treatment strategies for those who don’t benefit.

Authors of a recent study in the New England Journal of Medicine, "HER2 and Response to Paclitaxel in Node-Positive Breast Cancer," caution that their findings should not immediately change the way oncologists approach treatment. Importantly, other studies have shown that taxanes can be beneficial in women with ER positive and HER2 negative breast cancer. Moreover, there are newer and more effective ways of administering Taxol. Nevertheless, these results are part of a framework of studies suggesting that the benefits of chemotherapy vary according to the breast cancer subtype.

Komen’s Chief Scientific Advisor, Dr. Eric P. Winer, who was also an author on the study, commented: “We are learning more about which patients get the most benefit from treatments like chemotherapy. Increasingly, we are abandoning the view that a one size fits all approach works for women with breast cancer. In the years ahead, we anticipate ever greater individualization of treatment. For some women, that will mean skipping treatments like chemotherapy. For other patients, it may mean using chemotherapy even in the setting of very early stage breast cancer.”

For lots more information on chemotherapy, you can go to Studies section (left side of every page)-Conventional Therapy.

Demonstrating that it takes FOREVER for a new idea to work its way through the system - you can find below a May 12, 2006 New York Times article on "Shift in Treating Breast Cancer Is Under Debate". This article predicts it will take at least a decade to have consensus on this issue.

The Best Treatment for Breast Cancer?

Jan. 4, 2002 (Ivanhoe Newswire) -- New research suggests breast cancer patients with tumors less than a centimeter in size may be better off in the end if they forego treatment with chemotherapy and/or tamoxifen after their surgery.

Doctors know women with larger tumors benefit from additional, or adjuvant, therapy after initial treatment for their cancers. However, they are not sure whether women with very small tumors really need this treatment, since the risk of recurrence for them is so low.

In this study, investigators from UCLA found the risk of a long-term decline in physical functioning caused by the treatments outweighed any benefits of the additional therapy among women with very small tumors.

The study involved about 760 women who were an average of 6.3 years past their initial diagnosis of cancer and who had remained disease-free. Each filled out an extensive questionnaire on quality of life issues ranging from physical and social functioning to sexual desire and body image.

Results show breast cancer survivors report an excellent quality of life overall. However, when researchers compared results for women with very small tumors who had received additional treatment with chemotherapy and/or tamoxifen to those who had not received additional treatment, they found those who received additional therapy scored lower on physical functioning measures.

Patricia Ganz, M.D., from UCLA, is quoted as saying, "The question has been asked: Should every woman, even those with very small tumors, receive chemotherapy or tamoxifen or both after surgery? I think, in light of this research, the answer may be no.

This study shows there are some subtle costs to be paid with adjuvant therapy. But the only place this would carry any weight would be in women with tumors less than a centimeter in size."

SOURCE: Journal of the National Cancer Institute, 2002;94:39-49

Small Breast Tumors May Not Need Chemo

As reported at the San Antonio Breast Cancer Conference, 12/99

Systemic Overview of Chemo Effects

Acta Oncologica (Sweden), 8/01

Anemia in Breast Ca Pts Before/After Chemo
Testing if Chemo is Needed

Europe is using uPA and PAI

Survival/Tumor:Drug Resistance Assay
Genetic Test May Spare Chemo Use
Scintigraphic Imaging & Chemo Response

J Nuclear Medicien, 6/02

Estimate: 1-20 out of 100 Benefit w/Chemo

Boston Globe, 4/8/03

P53 Resistance to Paclitaxel
Synergistic Effects: Grape Seed Extract & Doxorubicin
Less Chemo Given to African-American Women

Breast Ca Res Treat, 9/03

Preop Chemo: NO SURVIVAL Advantage

Editorial JCO, 12/03

Higher Levels of uPA/PAI-1 Predicts Better Response to Chemo

Cancer Res, 1/04

No Clinical Impact to Reductions in Adjv Chemo: BCa

Abstract # 552 ASCO, 2004

MRI Identifies Responders w/Vascular Imaging:BCa
"Shift in Treating Breast Cancer is Under Debate"

New York Times, May 12, 2006

Adj Therapy & Cognitive Function - Chemo Brain

Study in Journal of Clinical Oncology shows there is "chemo brain" 7/00

Other Studies On Chemo Brain
Neuropsychologic Impact of Standard Dose Systemic Chemo
Subtle Cognitive Deficits Remain
Radiation Induces Neural Precursor-Cell Dysfunction
Current Knowledge/Research Directions-Bca
Diet in Cognitive Decline
Vitamins E & C: Cognitive Function
Abnormal Regional Brain Metabolism After Chemo
Card Game Tests Cognitive Functions
Cognitive Functioning Before Chemo: BCa
Physical Activity, Walking & Cognitive Function: Older Women
Long-term Cognitive Deficits/Dementia From Cancer
Who Benefits From Chemo in HR+, Node+ Postmenopausal Breast Cancer?

Presented at San Antonio Breast Cancer Symposium, 2009

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