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Titolo:
POLYCHEMOTHERAPY FOR EARLY BREAST-CANCER - AN OVERVIEW OF THE RANDOMIZED TRIALS
Autore:
ABE O; ABE R; ENOMOTO K; KIKUCHI K; KOYAMA H; NOMURA Y; SAKAI K; SUGIMACHI K; TOMINAGA T; UCHINO J; YOSHIDA M; BENRAADT J; VANDEVELDE AO; VANDONGEN JA; VERMORKEN JB; GIOKAS G; LISSAIOS B; HARVEY VJ; HOLDAWAY TM; KAY RG; MASON BH; COATES A; FORBES JF; FOCAN C; LOBELLE JP; GATES GD; POWELL J; DURAND M; MAURIAC L; BARTHOLOMEUS S; PICCART MJ; GELMAN RS; HENDERSON IC; SHAPIRO CL; HANCOCK AK; MASOOD MB; PARKER D; PRICE JJ; JACKSON S; RAGAZ J; DELOZIER T; MACELESECH J; HAYBITTLE JL; BERRY D; BROADWATER G; CIRRINCIONE C; MUSS H; NORTON L; BAUM M; HOUGHTON J; RILEY D; DENT DM; GUDGEON CA; HACKING A; GORDON NH; DAVIS HL; ROMESTAING P; LEHINGUE Y; OWEN JR; MEIER P; HOWELL A; RIBEIRO GC; SWINDELL R; ALBANO J; DEOLIVEIRA CF; GERVASIO H; GORDILHO J; CARSTENSEN B; PALSHOF T; JOHANSEN H; KORZENIOWSKI S; SKOLYSZEWSKI J; PORTNOJ SM; ANDERSEN KW; AXELSSON CK; BLICHERTTOFT M; MOURIDSEN HT; OVERGAARD M; ROSE C; CORCORAN N; TRAMPISCH HJ; COMIS RL; DAVIDSON NE; GRAY R; ROBERT N; TORMEY DC; WOOD W; CHETTY U; FORREST P; JACK W; ROSSBACH J; SYLVESTER RJ; VANDEVELDE CJH; CUNNINGHAM MP; BONNETERRE J; FUMOLEAU P; NAMER M; BASTERT G; RAUSCHECKER H; SAUER R; SAUERBREI W; SCHAUER A; SCHUMACHER M; DESCHRYVER A; BELFIGLIO M; MARI E; NICOLUCCI A; SCORPIGLIONE N; YOSEF HMA; MCARDLE CS; SMITH DC; LARA PC; BOCCARDO F; RUBAGOTTI A; ERAZO A; MEDINA JY; IZUO M; MORISHITA Y; BENTLEY A; DORAN Z; FENTIMAN IS; HAYWARD JL; RUBENS RD; KAUFMANN M; JONAT W; SCHEURLEN H; VONFOURNIER D; FOUNTZILAS G; KLAFSTROM P; BLOMQVIST C; CUZICK J; MARGREITER R; CASTIGLIONE M; CAVILLI F; COLLINS J; FORBES J; GELBER RD; GOLDHIRSCH A; LINDTNER J; PRICE KN; RUDENSTAM CM; SENN HJ; BLISS JM; CHILVERS CED; COOMBES RC; MARTY M; BOROVIK R; BRUFMAN G; HAYAT H; ROBINSON E; WIGLER N; PANNUTI F; TAKASHIMA S; YASUTOMI T; SONOO H; YAMASHITA J; OGAWA M; WELVAART K; HUPPERETS PSGJ; BONTE J; TENGRUP I; TENNVALLNITTBY L; MARTIN P; ROMAIN S; INGLE JN; SUMAN VJ; BUZDAR AU; SMITH T; HAKES T; WITTES R; DELAHUERTA R; SAINZ MG; BONADONNA G; DELVECCHIO M; VALAGUSSA P; VERONESI U; DUBOIS JB; BIANCO AR; LIPPMAN ME; PIERCE LJ; SIMON R; STEINBERG SM; MYLES JD; PATER JL; PRITCHARD KI; ANDERSON S; BROWN A; BRYANT J; COSTANTINO J; DIGNAM J; FISHER B; REDMOND C; WIEAND S; WOLMARK N; JACKSON IM; PALMER MK; BENGTSSON NO; LARSSON LG; LYTHGOE JP; KISSIN M; HANNISDAL E; VARHAUG JE; NISSENMEYER R; BLAMEY RW; MITCHELL AK; ROBERTSON JFR; UEO H; MATHE G; MISSET JL; ABUZAHRA HT; CLARKE EA; MCLAUGHLIN JR; CLARK RM; LEVINE M; MORIMOTO K; SAWA K; TAKATSUKA Y; GUNDERSEN S; HAUERJENSEN M; HOST H; CROSSLEY E; HARRIS A; BEIGHTON A; CLARKE M; COLLINS R; DAVIES C; EVANS V; GODWIN J; GREAVES E; HARWOOD C; JACKSON D; JAMES S; LAU E; MEAD G; NAUGHTEN A; PETO R; TOOTH A; RAMBERT P; ASSELAIN B; SALMON RJ; VILCOQ JR; ARRIAGADA R; HILL C; LAPLANCHE A; LE MG; SPIELMANN M; COCCONI G; DIBLASIO B; CATALANO R; CREECH RH; BROCKSCHMIDT J; COOPER MR; ANDRYSEK O; BARKMANOVA J; FALKSON CI; ABRAHAM M; KLIJN JGM; TREURNIETDONKER AD; VANPUTTEN WLJ; EASTON D; POWLES TJ; GAZET JC; SEMIGLAZOV V; DESHPANDE N; DIMARTINO L; DOUGLAS P; LINDTNER A; NOTTER G; BRYANT AJS; EWING GH; KRUSHENKOSLOSKI JL; GEORGE WD; GOULD A; STEWART HJ; STRONER P; MOLLER TR; RYDEN S; CARSTENSEN J; HATSCHEK T; SODERBERG M; CARPENTER JT; ALBAIN K; CROWLEY J; GREEN S; MARTINO S; OSBORNE CK; RAVDIN PM; RUTQVIST LE; WALLGREN A; HOLM LE; THURLIMANN B; BRENNER H; HERCBERGS A; YOSHIMOTO M; DEBOER G; PATERSON AHG; MEAKIN JW; PANZARELLA T; NAJA A; BAHI J; REID M; SPITTLE M; SENANAYAKE F; BERGH J; HOLMBERG L; SEVELDA P; ZIELINSKY CC; GNANT M; JAKESZ R; BUCHANAN RB; CROSS M; DUNN JA; GILLESPIE WM; KELLY K; MORRISON JM; LITTON A; CHLEBOWSKI RT; BEZWODA WR; CAFFIER H;
Indirizzi:
RADCLIFFE INFIRM,IMPERIAL CANC RES FUND,NUFFIELD DEPT CLIN MED,MRC,CLIN TRIAL SERV UNIT OXFORD OX2 6HE ENGLAND
Titolo Testata:
Lancet
fascicolo: 9132, volume: 352, anno: 1998,
pagine: 930 - 942
SICI:
0140-6736(1998)352:9132<930:PFEB-A>2.0.ZU;2-S
Fonte:
ISI
Lingua:
ENG
Soggetto:
REQUIRING PROLONGED OBSERVATION; ESTROGEN RECEPTORS; CHEMOTHERAPY; TAMOXIFEN; PATIENT; TUMORS; DESIGN; WOMEN;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
19
Recensione:
Indirizzi per estratti:
Citazione:
O. Abe et al., "POLYCHEMOTHERAPY FOR EARLY BREAST-CANCER - AN OVERVIEW OF THE RANDOMIZED TRIALS", Lancet, 352(9132), 1998, pp. 930-942

Abstract

Background There have been many randomised trials of adjuvant prolonged polychemotherapy among women with early breast cancer, and an updated overview of their results is presented. Methods In 1995, information was sought on each woman in any randomised trial that began before 1990 and involved treatment groups that differed only with respect to the chemotherapy regimens that were being compared. Analyses involved about 18 000 women in 47 trials of prolonged polychemotherapy versus nochemotherapy, about 6000 in 11 trials of longer versus shorter polychemotherapy, and about 6000 in 11 trials of anthracycline-containing regimens versus CMF (cyclophosphamide, methotrexate, and fluorouracil). Findings For recurrence, polychemotherapy produced substantial and highly significant proportional reductions both among women aged under 50at randomisation (35% [SD 4] reduction; 2p<0.00001) and among those aged 50-69 (20% [SD 3] reduction; 2p<0.00001); few women aged 70 or over had been studied. For mortality, the reductions were also significant both among women aged under 50 (27% [SD 5] reduction; 2p<0.00001) and among those aged 50-69 (11% [SD 3] reduction; 2p=0.0001). The recurrence reductions emerged chiefly during the first 5 years of follow-up,whereas the difference in survival grew throughout the first 10 years. After standardisation for age and time since randomisation, the proportional reductions in risk were similar for women with node-negative and node-positive disease. Applying the proportional mortality reduction observed in all women aged under 50 at randomisation would typically change a 10-year survival of 71% for those with node-negative disease to 78% (an absolute benefit of 7%), and of 42% for those with node-positive disease to 53% (an absolute benefit of 11%). The smaller proportional mortality reduction observed in all women aged 50-69 at randomisation would translate into smaller absolute benefits, changing a 10-year survival of 67% for those with node-negative disease to 69% (an absolute gain of 2%) and of 46% for those with node-positive disease to49% (an absolute gain of 3%). The age-specific benefits of polychemotherapy appeared to be largely irrespective of menopausal status at presentation, oestrogen receptor status of the primary tumour, and of whether adjuvant tamoxifen had been given. In terms of other outcomes, there was a reduction of about one-fifth (2p=0.05) in contralateral breast cancer, which has already been included in the analyses of recurrence, and no apparent adverse effect on deaths from causes other than breast cancer (death rate ratio 0.89 [SD 0.09]). The directly randomisedcomparisons of longer versus shorter durations of polychemotherapy did not indicate any survival advantage with the use of more than about 3-6 months of polychemotherapy. By contrast, directly randomised comparisons did suggest that, compared with CMF alone, the anthracycline-containing regimens studied produced somewhat greater effects on recurrence (2p=0.006) and mortality (69% vs 72% 5-year survival; log-rank 2p=0.02). But this comparison is one of many that could have been selected for emphasis, the 99% CI reaches zero, and the results of several ofthe relevant trials are not yet available. Interpretation Some monthsof adjuvant polychemotherapy (eg, with CMF or an anthracycline-containing regimen) typically produces an absolute improvement of about 7-11% in 10-year survival for women aged under 50 at presentation with early breast cancer, and of about 2-3% for those aged 50-69 (unless theirprognosis is likely to be extremely good even without such treatment). Treatment decisions involve consideration not only of improvements in cancer recurrence and survival but also of adverse side-effects of treatment, and this report makes no recommendations as to who should orshould not be treated.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 12/07/20 alle ore 13:24:43