Breast cancer systemic adjuvant therapy

Most breast cancers are diagnosed in early stages before the disease has disseminated to sites distant from the breast. Treatment consists of local management, as well as systemic adjuvant therapy with chemotherapy, hormonal therapy, or a combination of these. Breast-conservation therapy, which consists of complete removal of the tumor (lumpectomy), combined with breast irradiation and axillary lymph node sampling, is currently the preferred method of treatment for most patients with localized breast cancer. Patients who are not candidates for breast conservation or who do not choose this local therapy will generally receive the modified radical mastectomy. 

It is apparent from clinical and laboratory experiments and observation that the spread of breast cancer via the bloodstream occurs early in the course of the disease. This results in patients relapsing with systemic metastatic disease following local curative therapy. The likelihood of later development of metastatic disease is related to the size of the primary tumor, presence of lymph node involvement and number of nodes affected, and a number of additional pathologic prognostic factors, which include proliferative capacity, nuclear grade, hormone receptor status, and presence or absence of oncogenes and other protein products. Systemic adjuvant therapy is commonly... 

Lindley C, Vasa S, Sawyer WT, Winer EP. QuaUty of life and preferences for treatment following systemic adjuvant therapy for early stage breast cancer. J Clin Oncol 1998 16 380-387. 

Neoadjuvant chemotherapy is appropriate for patients with locally advanced or inflammatory breast cancer, followed by local therapy and further adjuvant systemic therapy. 

Harbeck N, Alt U, Berger U et al (2001) Prognostic impact of proteolytic factors (urokinase-type plasminogen activator, plasminogen activator inhibitor 1, and cathepsins B, D, and L) in primary breast cancer reflects effects of adjuvant systemic therapy. Clin Cancer Res 7 2757-2764... 

It is important to understand the relative and absolute magnitude of the benefit associated with adjuvant systemic therapy in breast cancer. Table 125-7 shows the proportional reduction in the annual odds of recurrence and death by age for adjuvant polychemotherapy and adjuvant tamoxifen given for 5 years in women with tumors that are positive for hormone receptors based on the results of these metaanalyses. Throughout these reports, the results are presented as they... 

Thomas E, Hortobagyi GN. New paradigms in adjuvant systemic therapy of breast cancer. Endocr Relat Cancer 2003 10 75-89. 

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