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Greatest benefit of chemotherapy in ER-negative tumors
Despite the common belief in the oncology community that cancer research and treatment have focused on breast tumors that
are estrogen receptor (ER)-positive, a researcher from The University of Texas M. D. Anderson Cancer Center maintains that
clinicians have made "enormous strides" in treating patients with tumors that are ER-negative.
In a presentation at the annual meeting of the San Antonio Breast Cancer Symposium, Donald Berry, Ph.D., a professor and
chair of the Department of Biostatistics and Applied Mathematics, looked at decades of breast cancer clinical trial
experience and found that "the benefit of chemotherapy advances over the last 20 years to ER-negative patients has been
surprisingly dramatic."
In examining the impact of chemotherapy treatment of node-positive breast cancer in three national clinical trials, which
enrolled more than 6,000 patients cumulatively, Berry found that chemotherapy has reduced the risk of death in ER-negative
patients by 56 percent. "The absolute benefit has been similarly impressive, especially in comparison with the corresponding
absolute benefit of chemotherapy to ER-positive patients," he says.
The studies, conducted by the Cancer and Leukemia Group B (CALGB) and the U.S. Breast Intergroup, all tested different
chemotherapy regimens and doses in women whose cancer had spread to their lymph nodes, and all three showed statistically
significant results. But, patients were treated "irrespective of hormone sensitivities or whether they had received tamoxifen
or not," Berry says. In women who are ER-positive, tamoxifen and other SERMs (selective estrogen receptor modulators) have
been shown to help prevent cancer development or recurrence.
The impact of such preventive treatments, however, was not "weighted" in these trials, he says. "People accept and act as
though chemotherapy is equally beneficial independent of ER status," he says. In his analysis, Berry found that all three
studies show that chemotherapy provided a statistically significant benefit for patients with ER-negative tumors, but "only a
little bit of an effect for ER-positive tumors that had been treated with tamoxifen, and none of the trials showed a
statistically significant benefit for higher doses of chemotherapy in ER-positive patients."
Berry says that the results will likely surprise oncologists "because everyone has assumed that ER status doesn't matter in
chemotherapy treatment, but here we show it does." That doesn't mean, however, that patients with ER-positive tumors should
not receive chemotherapy, Berry warns.
He adds that the study proves that breast cancer patients of both hormonal types are being aided by clinical advances. "The
prevailing wisdom has been that science has focused on ER-positive tumors, with development of SERMs and now aromatase
inhibitors, but ER-negative patients have been left in the lurch," Berry says. "Not so. This analysis demonstrates that
chemotherapy use has more than doubled survival rates in women with ER-negative tumors."
Contact: Nancy Jensen
nwjensen@mdanderson.org
713-792-0655
Heather Sessions
hrsessions@mdanderson.org
713-792 0655
M.D. Anderson Cancer Center, University of Texas
Cel mai mare beneficiu de chimioterapie în ER-negative tumorile - Greatest benefit of chemotherapy in ER-negative tumors - articole medicale engleza - startsanatate