Expert Panel Makes Recommendations about Breast Cancer Treatments for All Women (dateline November 7, 2000)

A panel of national and international experts said that in addition to surgery, most breast cancer patients should receive chemotherapy, hormonal therapy, or radiation therapy to improve their chances of surviving breast cancer. The panel convened at the three-day National Institutes of Health (NIH) Consensus Development Conference on Adjuvant Therapy for Breast Cancer, which was held from November 1 to November 3, 2000 at the NIH in Bethesda, Maryland. Among the panel’s top recommendations were chemotherapy for most women with localized breast cancer and hormonal therapy (most often with the drug tamoxifen) for women whose breast tumors are found to have estrogen receptors.

Adjuvant therapy is treatment that is given in addition to surgery. Panel chair Patricia Eifel, MD, Professor of Radiation Oncology at M.D. Anderson Cancer Center in Houston, Texas, and her colleagues said that a variety of factors should be considered when determining whether adjuvant therapy should be offered to breast cancer patients. These factors include:

• The woman’s age
• Tumor size
• Presence or absence of hormone receptors (for example, many breast cancer tumors have estrogen receptors and are found to respond to therapies that block estrogen from these receptors, such as tamoxifen)
• Presence or absence of cancerous lymph nodes

At the conference, the NIH panel made the following recommendations to help clarify questions from physicians and patients regarding breast cancer treatment options, quality of life, and new research:

Chemotherapy Recommendations

According to the NIH panel, treatment with chemotherapy drugs improves a woman’s chances of surviving breast cancer. Experts said that chemotherapy should be recommended to most pre-menopausal and post-menopausal women with localized breast cancer, regardless of whether their cancer has spread to the lymph nodes or has estrogen receptors.

The panel determined that chemotherapy with antracyclines (such as doxorubicin (brand name, Adriamycin) and epirubicin (brand name, Ellence)) show a small survival advantage over chemotherapy regimens that do not contain anthracyclines. The panel also said that that there is not enough data to determine whether chemotherapy with taxanes (such as docetaxel (brand name, Taxotere) or paclitaxel (brand name, Taxol)) is beneficial to women whose breast cancers do not involve the lymph nodes. There is also not enough evidence to determine whether dose-intensive treatment (e.g., high dose chemotherapy with stem cell support) improves a woman’s outcome, compared with standard combination chemotherapy regimens.

Hormonal Therapy Recommendations

The panel recommended that hormonal therapy (most commonly with tamoxifen) be offered to women whose breast tumors contain estrogen receptors, regardless of age, menopausal status, tumor size, or whether the cancer had spread to the axillary (underarm) lymph nodes. The experts said that research has shown that taking tamoxifen for five years is more beneficial to women than only taking tamoxifen for one or two years.

Currently, there is no evidence that tamoxifen should be used for more than five years outside of a clinical trial setting. However, the panel said that this would be an important area for investigation. The panel acknowledged that there is a small increased risk of developing endometrial cancer (cancer of the lining of the uterus) or thrombosis (blood clotting) for women who take tamoxifen. However, the benefit of treating breast cancer often outweighs these risks, according to the panel. Tamoxifen may be combined with combination chemotherapy, especially in pre-menopausal women, to reduce the chances of a recurrence of breast cancer.

Radiation Therapy Recommendations

Most women who have breast-conserving surgery (lumpectomy) undergo radiation therapy following surgery. The panel also recommended post-surgical radiation therapy for women who undergo mastectomy if they have large tumors or if four or more lymph nodes are found to be cancerous. The panel recommended that researchers investigate whether radiation therapy would be beneficial to women with three or fewer cancerous lymph nodes.

Panel Calls for Further Research

While the NIH panel made recommendations concerning adjuvant breast cancer therapies (chemotherapy, hormonal therapy, and radiation therapy), the experts said that many of these adjuvant therapies may have serious short-term or long-term side effects for some women, including premature menopause, weight gain, mild memory loss, and fatigue. Therefore, the panel called for further research to investigate quality of life measures associated with adjuvant breast cancer therapies. The experts said that long-term follow up was extremely important to understand the full impact of breast cancer treatments.

The panel recommended studies of:

• Combined hormonal therapy
• Hormonal therapy versus chemotherapy
• High-dose chemotherapy
• Chemotherapy with taxanes, such as docetaxel or paclitaxel
• Factors that predict the effectiveness of treatments in individual patients
• New drugs, including trastuzumab (brand name, Herceptin) and bisphosphonates
• Radiation techniques that reduce the dose to normal tissue such as the heart and lungs
• The effectiveness and side effects of adjuvant therapies in women older than 70 (to date, most trials have not included a sufficient number of women over age 70)

Additional Resources and References

• The November 3, 2000 National Institutes of Health (NIH) press release, "NIH Consensus Panel Recommends a Range of Adjuvant Therapies for Women with Breast Cancer," is available at http://www.nih.gov/news/pr/nov2000/omar-03.htm
• The full NIH Consensus Statement on Adjuvant Therapy for Breast Cancer is available by calling 1.888.NIH-CONSENSUS (1.888.644.2667) or online at http://odp.od.nih.gov/consensus/cons/114/114_intro.htm (read online or downloadable as a PDF file)
• To learn more about breast cancer treatment options, please visit http://www.imaginis.com/breasthealth/treatment.asp