Chemotherapy after Surgery Improves Survival When Some Breast Cancers Return ▲ NCI Cancer Bulletin for December 11, 2012 - National Cancer Institute

NCI Cancer Bulletin for December 11, 2012 - National Cancer Institute

Chemotherapy after Surgery Improves Survival When Some Breast Cancers Return

Among women whose breast cancer has recurred but not spread beyond nearby tissues, those who received chemotherapy after surgery had better disease-free and overall survival, a new study shows. Patients with estrogen receptor (ER)-negative tumors appeared to derive the greatest benefit. The results, from the CALOR trial, were presented December 6 at the San Antonio Breast Cancer Symposium .
"This is the first randomized controlled study that shows that adjuvant chemotherapy works in these patients," Dr. Stefan Aebi, head of the division of medical oncology at Luzerner Kantonsspital in Lucerne, Switzerland, and CALOR co-chair, said in a press release.
Dr. Aebi and his colleagues randomly assigned 162 women who had a local or regional recurrence following prior breast-conserving surgery or a mastectomy to receive adjuvant chemotherapy or not (85 and 77 women, respectively). The trial organizers recommended the use of combination chemotherapy and treatment for 3 to 6 months, but the choice of chemotherapy regimen was left to the discretion of patients' physicians. Treating physicians could also give patients radiation therapy, hormone therapy, or anti-HER2 therapy as appropriate.
Although the trial accrued fewer patients than planned, statistically significant differences were observed. After a median of 5 years of follow-up, the risk of recurrence was 41 percent lower in women treated with chemotherapy than in women who did not receive chemotherapy. And the overall survival rate was higher among patients who received chemotherapy than among those who did not, leading to a 59 percent reduction in the risk of death. (See the table.)

Rate of Disease-Free and Overall Survival, with and without Chemotherapy

	With Chemotherapy	Without Chemotherapy	P Value (0.05 and smaller are statistically significant)
Disease-Free Survival at 5 Years ER negative ER positive	69 percent 67 percent 70 percent	57 percent 35 percent 69 percent	0.0455 0.007 0.87
Overall Survival at 5 Years ER negative ER positive	88 percent 79 percent 94 percent	76 percent 69 percent 80 percent	0.02 0.12 0.12

When stratified by tumor type, there was a striking difference in the disease-free survival rate between women with ER-negative tumors who received chemotherapy and those who did not. Women with ER-positive tumors received appropriate hormonal therapy, and there were very few recurrences in that group, regardless of whether they received chemotherapy. Therefore, the majority of benefit was seen in women with ER-negative tumors.
These results show a "dramatic improvement in ER-negative [disease] using common chemotherapy drugs," said Dr. Jo Anne Zujewski, head of Breast Cancer Therapeutics in NCI's Division of Cancer Treatment and Diagnosis, who was not involved in the study. "[This] will be practice changing for a small subset of patients."
This trial was funded in part by NCI (U10-CA-37377, U10-CA-69974, U10-CA-12027, U10-CA-69651, and CA-75362).