Understanding Chemotherapy

Chemotherapy for breast cancer was first introduced 30 years ago, and doctors have been refining the treatment ever since.

Countless studies have asked which drugs work best and when they should be given, but many women still have not realized the full benefits of chemotherapy.

Today's issue of the New England Journal of Medicine has published a study comparing breast cancer chemotherapy treatments. Doctors looked at the effectiveness of a standard chemotherapy drug combination known as CMF (a cocktail of clophosphamide, methotrexate and fluorouracil) and compared it to taking CMF plus the drug epirubicin, known as an anthracycline.

Patients in the epirubicin-CMF group lived longer, cancer-free lives than the patients who received the standard CMF treatment, researchers said.

Several doctors commented about the significance of this study and where they believe breast cancer chemotherapy is headed:

Dr. Freya Schnabel Chief, Breast Surgery Section, Columbia University Medical Center and NewYork-Presbyterian, New York City The anthracycline drug studied here, epirubicin, is a drug used in the chemotherapy for breast cancer. Anthracyclines have been shown to be effective in the treatment of women with early-stage breast cancer.

This study was an attempt to clarify the benefits of chemotherapy for breast cancer using the drug epirubicin, as compared with other treatments that did not include this drug. The authors concluded that epirubicin treatments gave better results than the treatment regimens that did not include the drug.

As always, further study in this area may help physicians to determine the particular chemotherapy regimen that is best for an individual patient's cancer.

Dr. Clifford Hudis Chief, Breast Cancer Medicine Service, Memorial Sloan Kettering Cancer Center, New York City This study confirms that anthracyclines are more effective than other older chemotherapy regimens and options. But some specific types of breast cancer may benefit more than others from the use of anthracyclines, so that some patients may be able to safely avoid anthracyclines {epirubicin}, which can have toxic side effects.

One doctor notes that this finding isn't anything new, and that's a good thing.

Dr. Marisa Weiss President and Founder, breast cancer.org For 10 years, we've known the superiority of athracycline-based treatment over CMF for women with early-stage disease. These clinical trial results no longer address essential clinical questions, leading us to draw another conclusion: The relative clinical irrelevance of these studies reflects significant clinical progress in oncology -- that's a good thing.

Dr. Raphael Catane Department of Oncology at Sheba Medical Center, Tel Hashomer, Israel The hope for the future is that we will have better tools (such as the modern test Oncotype DX) to select the appropriate treatment.

Dr. Eric P Winer Director, Breast Oncology Center, Dana Farber Cancer Institute, Boston Mass. Women today need to know as much as possible about their cancer risk and the evidence and the benefits of therapy given their particular tumor type. In some cases, but not all, that involves the test Oncotype DX. A woman and her doctor then need to factor in her personal preferences.