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| |  ASCO-DG DISPATCH: Breast Cancer Meeting Highlights By Robert H. Carlsen Special to DGNews LOS ANGELES, CA -- May 20, 1998 -- Breast cancer is a scourge women rightly fear as frustratingly little can be done to prevent it. Women -- especially those who don't smoke, exercise, stay lean and eat their vegetables -- can still develop the disease, even if they have no family history. These data on breast-cancer prevention and treatment were highlights of today's sessions at the American Society of Clinical Oncology's 34th annual meeting. Tamoxifen Prevents Both Invasive And Non-Invasive Disease The hormonal therapy tamoxifen reduced rates of invasive and non-invasive breast cancers, according to results from a National Surgical Adjuvent Breast and Bowel Project (NSABP) co-operative study group's trial. The trial included 13,388 healthy women who had a five times or more than average risk of breast cancer. With almost four years follow-up, researchers reported 154 cases of invasive disease in the placebo group, compared to 85 among women taking tamoxifen, a 45 percent reduction. Tamoxifen also reduced non-invasive breast cancer compared to placebo -- 59 cases versus 31 cases, respectively. Tamoxifen therapy reduced the risk of fractures of the hip, spine and wrist by 35 percent. The researchers found no difference in the incidence of heart disease between tamoxifen and placebo. The risk of endometrial cancer was increased about 2.5 fold with tamoxifen (33 versus 14 cases) and pulmonary and deep-vein thrombosis rates increased with tamoxifen (47 versus 25). But the excess risk of endometrial cancer, a rare-but-serious side effect of tamoxifen therapy, was not evident among women who were age 49 years or less at time of entry into the trial. News On Raloxifene Raloxifene is similar to tamoxifen in that both are SERMs (selective estrogen receptor modulator). Data presented here show that raloxifene reduces the risk of breast cancer as tamoxifen does, but in addition, Raloxifene does not appear to increase the risk of endometrial cancer. Results on the MORE trial (Multiple Outcomes of Raloxifene Evaluation) were presented by Steven Cummings, MD, University of California-San Francisco. His data was based on 7,705 postmenopausal women up to age 80 years with osteoporosis who received daily raloxifene 60mg, raloxifene 120mg or placebo for an average of 33 months. Raloxifene is currently FDA-approved only for treatment of osteoporosis in post-menopausal women. Two-year interim data from this trial show the incidence of breast cancer in the women taking placebo was 0.82 percent, compared with 0.21 percent for women taking either dose of raloxifene. The overall relative risk of endometrial cancer was only 0.38 for women taking raloxifene, a relative risk that went even lower, to 0.13, if the two cases diagnosed within one month of the beginning of the trial are excluded. Dr. Cummings explained that the long-term effects of this hormonal treatment are unknown. He added this is an important question since some women could be prescribed raloxifene for osteoporosis for decades of postmenopausal life. He said it would be incorrect to make any comparisons between this raloxifene trial of older women (in whom osteoporosis is associated with a lower incidence of breast cancer), with Dr. Wickerham's NSABP trial of younger, high-risk women. Adding Taxol Helps Early Disease Increasing the dose of adriamycin does not improve results in women receiving breast-cancer chemotherapy, but adding the drug Taxol does improve results slightly. A trial randomising 3,100 women with early-stage, node-positive, operable breast cancer to three doses of adriamycin and further randomising half of the subgroups to receive Taxol, found there is no advantage to increasing adriamycin beyond standard dosages. However, 90 percent of women receiving Taxol were relapse-free at three years, compared to 86 percent of women receiving adjuvant therapy alone. The mortality rate was also somewhat lower -- 97 percent of women receiving Taxol were alive at one year, compared to 95 percent of those on standard Adriamycin-cyclophosphamide therapy. "These are early results, but we know that once we establish a trend toward reduction in the mortality rate, that trend will continue for years," explained Craig Henderson, MD, co-principal investigator of the study.
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