Breast cancer, node-positive

The addition of taxanes, docetaxel and paditaxel, a newer class of agents, to adjuvant regimens comprised of the drugs listed above resulted in consistently and significantly improved disease-free survival and OS in node-positive breast cancer patients. 

Dose-dense regimens may be considered as options for adjuvant therapy for node-positive breast cancer. 

Ravdin PM, Fritz NF, Tormey DC, Jordan VC (1988) Endocrine status of postmenopausal node-positive breast cancer patients following adjuvant chemotherapy and long-term tamoxifen. Cancer Res 48 1026-1029... 

Thor AD, Berry DA, Budman DR, Muss HB, Kute T, Henderson IC, Barcos M, Cirrincione C, Edgerton S, Allred C, Norton L, Liu ET. erbB-2, p53, and efficacy of adjuvant therapy in lymph node-positive breast cancer. J Natl Cancer Inst 1998 90(18) 1346-60. 

Poikonen P, Saarto T, Lundin J, Joensuu H, Blomqvist C. Leucocyte nadir as a marker for chemotherapy efficacy in node-positive breast cancer treated with adjuvant CMF. Br J Cancer 1999 80(ll) 1763-6. 

Cardoso F, Ferreira FUho AF, Crown J, Dolci S, Paesmans M, Riva A, Di Leo A, Piccart MJ. Doxorubicin followed by docetaxel versus docetaxel followed by doxorubicin in the adjuvant treatment of node positive breast cancer results of a feasibihty study. Anticancer Res 2001 21(lB) 789-95. 

Qinkal uses Advanced ovarian carcinoma, node-positive breast cancer (adjuvant), metastatic breast cancer, non-small cell lung cancer, cervical, bladder, head and nedc cancer, AIDS-related Kaposi s sarcoma (second line). 

Gasparini, G., Barbareschi, M., Doglioni, C., Palma, P. D., Mauri, F. A., Boracchi, P., Bevilacqua, P., Caffo, O., Morelli, L., Verderio, P., Pezzella, F., and Harris, A. L. (1995) Expression of bcl-2 protein predicts efficacy of adjuvant treatments in operable node-positive breast cancer. Clin. Cancer Res. 1, 189-198. 

Colleoni M, Gelber S, Goldhirsch A, et al. Tamoxifen after adjuvant chemotherapy for premenopausal women with lymph node-positive breast cancer International Breast Cancer Study Group Trial 13-93. J CUn Oncol 2006 24(9) 1332-41. 

While the incorporation of the taxanes into many different regimens, both sequentially and concurrently, has lead to a shift in therapy for node-positive breast cancer patients, the use of taxane-containing regimens in node-negative patients remains controversial. The use of an anthracycline-containing regimen has been established for both node-negative and node-positive breast cancer patients. 

Mamounas EP, Bryant J, Lembersky BC, et al. PacUtaxel (T) following doxorubicin/cyclophosphamide (AC) as adjuvant chemotherapy for node-positive breast cancer results from NSABP B-28 (Meeting abstract). Proc Am Soc CUn Oncol 2003 A 12. 

Bonadonna G, Valagussa P, MoUtemi A, et al. Adjuvant cyclophosphamide, methotrexate, and fluorouracil in node-positive breast cancer The results of 20 years of follow-up. N Engl J Med 1995 332 901-906. 

Jonat W, Kaufmann M, Sauerbrei W, et al. Goserelin versus cyclophosphamide, methotrexate and fluorouracil as adjuvant therapy is premenopausal patients with node-positive breast cancer The Zoladex Early Breast Cancer Research Association Study. J Clin Oncol 2002 20 4628-4635. 

Holli, K., Valavaara, R Blanco, G., Kataja, V., Hietanen, P., Flander, M., Pukkala, E. and Joensuu, H. (2000) Safety and efficacy results of a randomized trial comparing adjuvant toremifene and tamoxifen in postmenopausal patients with node-positive breast cancer. Finnish Breast Cancer Group. Journal of Clinical Oncology, 18, 3487-3494. 

Hayes DF, Thor AD, Dressier LG, et al. HER2 and response to paclitaxel in node-positive breast cancer. N Engl J Med. 2007 357 1496-1506. 

Menard S, Valagussa P, Pilotti S, et al. Response to cyclophosphamide, methotrexate, and fluorotrracil in lymph node-positive breast cancer according to HER2 overexpression and other tumor biologic variables. / Clin Oncol. 2001 19 329-335. 

Adjuvant chemotherapy with CMF administered to premenopausal women with axillary node positive breast cancer (B3) induced permanent ovarian suppression in 47 of 77 (61%) patients. After a median observation time of 37 months, the relapse-free and overall survival times were significantly longer for patients with permanent amenorrhoea. A strongly positive correlation between CMF-induced amenorrhoea and age of the patients, as well as between age and tumor PRP status, was found. The induction of ovarian suppression predominantly occurs in patients with PRP positive tumors and may add an endocrine effect to the cytotoxic action of adjuvant chemotherapy in this particular group of older premenopausal women. 

Newer analogs of doxorubicin valrubicin (Valstar) was approved in 1998 for intravesical therapy of baciUe Calmette-Guerin-refractory urinary bladder carcinoma in situ in patients for whom immediate cystectomy would be associated with unacceptable morbidity or mortality epirubicin (4 -epidoxorubicin, EUence) was approved by the FDA in 1999 as a component of adjuvant therapy following resection of early lymph-node-positive breast cancer. 

B. (2003) Type 1 growth factor receptor expression in node positive breast cancer adverse prognostic significance of c-erbB4. J Clin Pathol 56, 300-304. 

Schindl M, Schoppmann SE, Samonigg H, et al. Overexpression of hypoxia-inducible factor lalpha is associated with an unfavorable prognosis in lymph node-positive breast cancer. Clin Cancer Res 2002 8 1831-1837. 

H. Muss, et al., Toxicity of Older and Younger Patients Treated With Adjuvant Chemotherapy for Node-Positive Breast Cancer The Cancer and Leukemia Group B Experience, Journal of Clinical Oncology 25, no. 24 (2007) 3699-3704. 

Roy C, Choudhury KB, Pal M, Saha A, Bag S, Baneijee C. Adjuvant chemotherapy with six cycles of AC regimen versus three cycles of AC regimen followed by three cycles of Paclitaxel in node-positive breast cancer. Indian J Cancer 2012 49 266-271. 

Paclitaxel, given 3-weekly, was previously indicated in the adjuvant treatment of nodepositive breast cancer, following anthracycline and cyclophosphamide chemotherapy, but a large randomized study showed that weekly paclitaxel or 3-weekly docetaxel regimens are superior [3 ]. Thus, in the UK NICE recommends the use of docetaxel rather than paclitaxel as adjuvant treatment for lymph node-positive breast cancer [4 ]. 

Docetaxel is indicated, in combination with doxorubicin and cyclophosphamide, for adjuvant treatment of node-positive breast cancer and, in combination with doxorubicin, for treating locally advanced or metastatic breast cancer. It is also indicated as monotherapy or in combination with capecitabine for the treatment of locally advanced or metastatic breast cancer in patients who have relapsed or progressed after previous anthracycline or alkylating agents. It can be administered concurrently with trastuzumab, with which it is synergistic in vitro [1091], unlike paclitaxel, which appears to have simply an additive effect with trastuzumab [110 ]. 

Epirubicin [12 ] 1999 Axillary node-positive breast cancer 100-120mg/m2 IV 3-4week cycles Max cumulative dose 900mg/m Recommended dose 720mg/m ... 

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