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Threefold therapy for breast cancer.


A regimen of three drugs administered before surgery and radiation treatments shows promising results for patients with advanced breast cancer as a result of an 11-year study conducted at the University of Texas M.D. Anderson Cancer Center in Houston.

"Ten years after diagnosis, 30 percent of the patients involved in the study are alive without evidence of disease--better results than treating similar patients with surgery and radiation alone," says Dr. Gabriel N. Hortobagyi, professor of medicine at the Houston facility and the study's principal investigator. Hortobagyi and his associates treated 174 patients with stage III breast cancer, defined as locally advanced primary breast cancer with various degrees of local and regional extension and markedly different prognoses after local therapies. The patients, both operable and inoperable, were treated with three drugs--5-fluorouracil, doxorubicin and cyclophosphamide--before undergoing surgery and radiation therapy. All but six of the 174 were rendered disease-free after chemotherapy and local treatment.

"This report involves the largest group of patients followed for the longest period of time using this particular three-drug regimen," says Dr. Charles M. Balch, chief of the M.D. Anderson Division of Surgery and a co-investigator in the study. "The study suggests that there is a biological advantage to giving drug therapy before surgery."

Hortobagyi says the anti-cancer drugs used in the study served to shrink the primary tumors, allowing for more conservative surgery. The drugs also eliminated malignancies that had broken away from the primary tumors but had not yet formed secondary tumors. The Houston study was also able to tell which drugs responded the best and the quickest to each tumor. Hortobagyi says it is significant that the treatment decreased the incidence of distant tumor transference and consequently improved the survival rate among patients involved in the study that began in 1974.

"It is also important to note that some patients who responded well to the chemotherapy could be treated without a mastectomy, thus achieving breast preservation in addition to long-term survival," he adds. Before the development of combination chemotherapy, patients with stage III breast cancer were treated with high dosages of radiation therapy, preceded or followed by a mastectomy. Yet, says Hortobagyi, 25-60 percent of these patients developed local recurrences in the same areas in which they had either had surgery or radiation. The 10-year survival rate after diagnosis with the three-drug study was 56 percent for stage IIIA (operable) patients, and 26 percent for stage IIIB (generally inoperable); those figures, Hortobagyi points out, used to be practically zero regardless of the classification.

Modifications of this treatment strategy, says Hortobagyi, might result in further improvement of survival rates, as well as whether further treatment is necessary if a patient shows a good early response. (Cancer, December 15, 1988; 62:2507-2516.)
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Title Annotation:research at University of Texas M.D. Anderson Cancer Center
Publication:Medical Update
Date:Feb 1, 1989
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