In a nutshell
In this study chemotherapy and Tamoxifen were compared to Tamoxifen alone as complementary treatments after surgery for breast cancer. The main finding was that better results are obtained by adding chemotherapy.
Some background
Tamoxifen is a drug used for tumors which require the female hormone estrogen to grow. It acts by blocking the cancer’s ability to recognize the estrogen, and stopping its growth. If the pathology report determines that the tumor has hormone receptors, Tamoxifen will be considered as post-operative therapy. Chemotherapy (CHT) can also be used to further limit the risk of cancer recurrence after initial treatment. Despite being very effective, CHT has many side effects, including infection, leukemia, blood clots and heart failure. These need to be considered when choosing a particular treatment regimen.
Methods & findings
The trial included 1477 women with breast cancer spread to the lymph nodes. After surgery (either lumpectomy or mastectomy), three strategies were used:
– 361 patients received Tamoxifen alone;
– 566 received CHT followed by Tamoxifen;
– 550 received CHT and Tamoxifen at the same time.
The main outcome was that best results were obtained when using CHT followed by Tamoxifen. In this group, the estimated disease-free survival (survival without recurrence) at 10 years was 60%. CHT and tamoxifen at the same time ranked second (disease-free survival – 53%). Tamoxifen alone only offered an estimated 10-year disease-free survival of 48%. Overall survival rates followed the same pattern.
The bottom line
The results prove that a combined regimen which includes CHT and Tamoxifen is indeed very efficient.
The fine print
However, the benefits need to be adjusted depending on individual risks for complications due to aggressive chemotherapy.
Published By :
The Lancet
Date :
Dec 19, 2009
