03:51am Thursday 28 May 2020

Chemotherapy After Complete Surgical Removal of a Local or Regional Breast Cancer Recurrence Increased Survival Rates, AGH/NSABP Researchers Find

Patients with isolated local and/or regional recurrence of their breast cancers are at high risk for developing metastases in other areas of the body. Some physicians administer chemotherapy to these patients after their recurrent tumors have been completely removed by surgery, but the efficacy of this treatment had not been studied until now.
“This is the first randomized controlled study that shows that adjuvant chemotherapy works in these patients,” said lead investigator Stefan Aebi, M.D., head of the division of medical oncology at Luzerner Kantonsspital in Luzern, Switzerland
Norman Wolmark, MD, Chairman of the NSABP and Professor of Surgery at AGH, served as a principal investigator for the study along with Charles Geyer, MD, former director of the AGH Cancer Center, and former Director of Medical Affairs at the NSABP.
Drs. Wolmark and Geyer, together with colleagues from the Breast International Group, the NSABP and the International Breast Cancer Study Group evaluated 162 patients with isolated local and regional recurrence; 85 received adjuvant chemotherapy and 77 did not.
Five-year disease-free survival rates were 69 percent for women who received adjuvant chemotherapy and 57 percent for those who did not. The overall survival rate was 88 percent for women who received chemotherapy compared with 76 percent for those who did not.
Women with estrogen receptor (ER)-negative breast cancer demonstrated the greatest benefit, with a five-year disease-free survival rate of 67 percent among those who received chemotherapy versus 35 percent among those who did not. In addition, within this group, overall survival rates were 79 percent among those who received chemotherapy and 69 percent among those who did not.
For patients with ER-positive disease, five-year disease-free survival was 70 percent for those who received chemotherapy versus 69 percent for those who did not. Overall survival was 94 percent for those patients with ER-positive disease who received chemotherapy versus 80 percent among those who did not.
Dr. Aebi recommended that physicians prescribe adjuvant chemotherapy for patients with isolated local and regional recurrence of breast cancer, especially if the recurrence is ER-negative and therefore not sensitive to endocrine therapy.
Genetics May Be Key To Those Who Benefit from Adjuvant Chemotherapy
Cancer researchers from AGH and the NSABP made several additional presentations at the San Antonio Breast Cancer Symposium. 
Dr. Wolmark, along with Thomas B. Julian, MD, Associate Director of the Breast Care Center at AGH, Principal NSABP Investigator at AGH and Associate Director of Medical Affairs at NSABP, and D. Lawrence Wickerham, MD, Chief of the Section of Cancer Genetics at AGH and Associate Chairman of the NSABP, are principal investigators for a clinical trial that showed how a patient’s genetics may determine the likelihood she will benefit from adjuvant chemotherapy.
The researchers found that over an 11-year span, the 21-gene recurrence score, or OncotypeDX, significantly predicted the outcome for certain types of patients treated with chemotherapy. The trial looked at patients with node-positive, estrogen-receptor positive breast cancer, and the results could help these patients and their physicians make treatment decisions, or target patients who are at high risk of recurrence with additional therapies.
Drs. Julian and Wolmark will also present updated results from an ongoing clinical trial examining whether adding trastuzumab to radiation therapy will improve results for patients with HER2-positive DCIS (Ductal Carcinoma in Situ) who have undergone lumpectomy. These patients may be at risk for local recurrences.
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