8. Adjuvant systemic therapy for women with node-positive breast cancer

February 1998
CMAJ: Canadian Medical Association Journal;02/10/98 Supplement, Vol. 158, pS52
Academic Journal
Objective: To facilitate the choice of systemic adjuvant therapy for women with node-positive breast cancer. Evidence: Systematic review, using MEDLINE from 1976 and CANCERLIT from 1983 to December 1996. Nonsystematic review continued through June 1997. Recommendations: • Chemotherapy should be offered to all premenopausal women with stage II breast cancer. • Acceptable treatments regimens are those using cyclophosphamide, methotrexate and 5-fluorouracil (CMF) or doxorubicin (Adriamycin) and cyclophosphamide (AC). Cyclophosphamide, epirubicin and 5-fluorouracil (CEF) may be shown in the future to result in belier disease-free survival than CMF. Personal choice, quality of life and costs also influence this choice. • Systemic adjuvant chemotherapy should begin as soon as possible after the surgical incision has healed. • The recommended duration of therapy is at least 6 cycles (6 months) for CMF or CFF, and at least 4 cycles (2 to 3 months) for AC. • The recommended CMF regimen consists of 14 days of oral cyclophosphamide with intravenous methotrexate and 5 fluorouracil (5-FU) on days 1 and 8. This is repeated every 28 days for 6 cycles. • Potential toxic effects should be fully discussed with patients. • When possible, patients should receive the full standard dosage. No recommendations about high-dose chemotherapy can yet be made. Ovarian ablation is effective in premenopausal women with estrogen receptor-positive tumours. However, chemotherapy has been better studied and is considered the intervention of choice. Ovarian ablation should be recommended to women who decline chemotherapy. • In the future, a small benefit may be shown for the combination of ovarian ablation plus chemotherapy in women with node-positive, estrogen receptor-positive cancers. At present there is insufficient evidence for this to be recommended. • Tamoxifen should not be recommended as the sole treatment for premenopausal women with node positive tumours. • Routine use of tamoxifen after chemotherapy in premenopausal women cannot yet be recommended. • Before recommending hormonal therapy in premenopausal women, both the long-term side effects and its effects on recurrence must be considered. • Postmenopausal women with stage II, estrogen receptor-positive cancer should be offered adjuvant tamoxifen. • The recommended duration of tamoxifen therapy is 5 years. • No other hormonal intervention apart from tamoxifen can be recommended for postmenopausal patients. • Women with estrogen receptor-negative tumours who are fit to receive chemotherapy (generally younger than 70 years) should be offered CMF or AC. There is no proof that tamoxifen adds any benefit to chemotherapy. Tamoxifen alone may be of value. • Women with estrogen receptor-positive tumours may gain a small additional benefit from taking chemotherapy in addition to tamoxifen. This is an option for a motivated, well-informed patient. • Patients should be offered the opportunity to participate in clinical trials whenever possible. Validation: The authors' original text was revised by a writing committee, primary and secondary reviewers, and by The Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. The final document reflects a consensus of all these contributors. Sponsor: The Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer was convened by Health Canada. Completion date: July 1, 1997


Related Articles

  • Helping Patients Make Informed Choices: A Randomized Trial of a Decision Aid for Adjuvant Chemotherapy in Lymph Node-Negative Breast Cancer. Whelan, Timothy; Sawka, Carol; Levine, Mark; Gafni, Amiram; Reyno, Leonard; Willan, Andrew; Julian, Jim; Dent, Susan; Abu-Zahra, Hakam; Chouinard, Edmond; Tozer, Richard; Pritchard, Kathleen; Bodendorfer, Ilona // JNCI: Journal of the National Cancer Institute;4/16/2003, Vol. 95 Issue 8, p581 

    Background: In recent years, patients have indicated a desire for more information about their disease and to be involved in making decisions about their care. We developed an aid called the "Decision Board" to help clinicians inform patients with lymph node-negative breast cancer of the risks...

  • Epirubicin for breast cancer may cause considerable venous sclerosis. Bolton-Maggs, Paula; Flavin, Aileen // BMJ: British Medical Journal (International Edition);10/8/2005, Vol. 331 Issue 7520, p816 

    Discusses the use of epirubicin for adjuvant treatment in breast cancer patients. Details of the chemotherapy and symptoms in two women who developed venous sclerosis after epirubicin infusions; Indication that complications from the drug were known, but not reported; Idea that a limited...

  • Anthracycline War: No Victor Yet. Young, Patrick // JNCI: Journal of the National Cancer Institute;9/2/2009, Vol. 101 Issue 17, p1171 

    The article discusses the debate on the use of anthracyclines for early breast cancer therapy. The strength of research suggesting that anthracyclines may work only in women with extra copies of the HER2 protein or overexpression of the gene is being questioned. Concerns over the side effects of...

  • Prophylactic Effect of Lamivudine for Chemotherapy-Induced Hepatitis B Reactivation in Breast Cancer: A Meta-Analysis. Tang, Wei; Chen, Lun; Zheng, Ruohui; Pan, Lingxiao; Gao, Jin; Ye, Xigang; Zhang, Xiaoshen; Zheng, Wenbo // PLoS ONE;Jun2015, Vol. 10 Issue 6, p1 

    Background: Three strategies using lamivudine have been proposed to prevent chemotherapy-induced HBV (hepatitis B virus) reactivation in the clinical setting. The purpose of this meta-analysis is to evaluate the efficacy of the early preemptive strategy, deferred preemptive strategy and...

  • Assessment of Early Tumor Response to Cytotoxic Chemotherapy with Dynamic Contrast-Enhanced Ultrasound in Human Breast Cancer Xenografts. Wang, Jian-Wei; Zheng, Wei; Liu, Ji-Bin; Chen, Yao; Cao, Long-Hui; Luo, Rong-Zhen; Li, An-Hua; Zhou, Jian-Hua // PLoS ONE;Mar2013, Vol. 8 Issue 3, p1 

    There is a strong need to assess early tumor response to chemotherapy in order to avoid adverse effects from unnecessary chemotherapy and allow early transition to second-line therapy. This study was to quantify tumor perfusion changes with dynamic contrast-enhanced ultrasound (CEUS) in the...

  • The Impact of Outpatient Chemotherapy-Related Adverse Events on the Quality of Life of Breast Cancer Patients. Tachi, Tomoya; Teramachi, Hitomi; Tanaka, Kazuhide; Asano, Shoko; Osawa, Tomohiro; Kawashima, Azusa; Yasuda, Masahiro; Mizui, Takashi; Nakada, Takumi; Noguchi, Yoshihiro; Tsuchiya, Teruo; Goto, Chitoshi // PLoS ONE;Apr2015, Vol. 10 Issue 4, p1 

    The objective of our study was to clarify the impact of adverse events associated with the initial course of outpatient chemotherapy on the quality of life of breast cancer patients. We conducted a survey to assess the quality of life in 48 breast cancer patients before and after receiving their...

  • Nursing Considerations for Capecitabine-Based Combination Therapy. Becze, Elisa // ONS Connect;Apr2009, Vol. 24 Issue 4, p14 

    The article presents a summary of the article "Capecitabine-Based Combination Therapy for Breast Cancer: Implications for Nurses" by Debra K. Frye published in the January 2009 issue of "Oncology Nursing Forum." It discusses Capecitabine combination therapy, results of studies on its use, and...

  • KEMOTERAPÄ° ALAN MEME KANSERLÄ° HASTALARDA, KEMOTERAPÄ°NÄ°N YAN ETKÄ°LERÄ°NE Ä°LÄ°ÅžKÄ°N VERÄ°LEN EĞİTÄ°M VE EVDE Ä°ZLEMÄ°N YAÅžAM KALÄ°TESÄ°NE ETKÄ°SÄ°NÄ°N... Akçay, Duygu; Gözüm, Sebahat // Meme Sagligi Dergisi / Journal of Breast Health;2012, Vol. 8 Issue 4, p191 

    Purpose: In this research, breast cancer patients receiving chemotherapy were evaluated for side effects of chemotherapy on their quality of life following education and home follow-up. Patients and Methods: This study was carried out in accordance with the principles of the pre/post test...

  • Grossesse après cancer du sein. Margulies, A.; Uzan, C. // Oncologie;May2013, Vol. 15 Issue 5, p251 

    Concerning the desire of pregnancy after breast cancer, several issues have to be discussed with the patient, such as risk of cancer recurrence or optimal time between cancer and future pregnancy. Potential obstetrical complications, long-term teratogenicity of anti-cancer drugs or breast...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics