Refined chemo benefits ER-negative patients.(Gynecology)

SAN ANTONIO -- Twenty years of refinements in adjuvant chemotherapy have brought dramatically improved outcomes in lymph node-positive breast cancer patients, but the benefit has been confined to those with estrogen receptor-negative tumors, Donald A. Berry, Ph.D., said at a breast cancer symposium sponsored by the Cancer Therapy and Research Center.

In patients with node-positive, estrogen receptor-positive breast cancer, hormone therapy--first with tamoxifen, now increasingly with aromatase inhibitors--has resulted in better outcomes over the past 2 decades. There are no comparable treatments specifically targeting ER-negative tumors. But the benefits of chemotherapy in node-positive patients with ER-negative disease are "enormously greater" than in ER-positive women, according to Dr. Berry, professor and chair of the department of biostatistics and applied math at M.D. Anderson Cancer Center, Houston.

He illustrated his point via a review of the three most recent Cancer and Leukemia Group B (CALGB) randomized trials of various chemotherapy regimens in women with node-positive breast cancer. The three studies collectively included 6,644 patients, of whom 2,537 were ER negative. The first of the studies, CALGB 8541, began accruing patients 20 years ago. The most recent, CALGB 9741, started enrollment in the late 1990s.

Each trial randomized patients to lower-dose, less intensive chemotherapy regimens or higher-dose, more aggressive ones. In each study, patients with ER-negative disease who were assigned to the more intensive regimens had significantly greater improvements in disease-free and overall survival than women on conservative, lower-dose chemotherapy. And in each study, the benefits of more modern, aggressive chemotherapy didn't come close to achieving significance in patients with ER-positive breast cancer who were on adjuvant tamoxifen.

The relative reductions in relapse risk in ER-negative patients ...