Yes. Several studies have now shown that postmenopausal women with cancer that has spread to underarm lymph nodes are helped by adjuvant chemotherapy as much as premenopausal women with the same node status.
Also, the benefit to be obtained from appropriate chemotherapy is superior to that of endocrine therapy alone.
Appropriate chemotherapy uses a combination of drugs. Some regimens add endocrine therapy to cell-killing drugs.
Obtaining the best results requires considering compromised organ functions, altered drug metabolism and individual variations in the toxic side effects. But age alone is no basis for compromising effective treatment of micrometastatic cancer.
Later in the course of advancing metastatic breast cancer, some of the very same patients, who'll then be somewhat older, will be exposed to chemotherapeutic agents. Thus, rather than avoiding chemotherapy, postmenopausal patients will receive it when it has less chance of prolonging either life or freedom from disease.
When chemotherapy can be given within the limits of tolerance, the patient gains more in productive life than the time committed to chemotherapy.
If one trangresses the tolerance limit, chemotherapy should be stopped or avoided. But until we learn to prevent cancer, both curative and palliative efforts are important.
All postmenopausal women are not octogenarians, and many of those who are cling tenaciously to hopes of cure. Despite the imperfections of today's chemotherapy for such patients, it is effective in prolonging disease-free survival -- a prerequisite to cure. -- Dr. James F. Holland chairman, Department of Neoplastic Diseases, and director of the Cancer Center at Mount Sinai School of Medicine, New York
No. This group of patients should not be treated with adjuvant chemotherapy except in controlled trials.
No single trial with postmenopausal node-positive women randomized to chemotherapy or just local therapy has shown a statistically significant survival advantage. The same is true of trials comparing a more intense regimen with a less intense one, such as use of a single agent.
A possible exception is the National Surgical Adjuvant Breast and Bowel Project (NSABP) trial, with patients randomized to receive 5-FU and L-phenylalanine mustard, or the same two drugs with doxorubicin (Adriamycin, Adria). The patients who were given doxorubicin reportedly have longer overall survival. These results are preliminary and have not been confirmed by other investigators.
A recent overview analysis by Richard Peto and his colleagues at Oxford found that adjuvant chemotherapy for postmenopausal women with positive nodes yields an overall survival advantage with high statistical significance.
But the individual trials, with 300 to 500 patients each, fail to show a statistically significant benefit. So one must conclude that the magnitude of the effect is very small.
This renders the therapy's substantial toxicities very important. It hardly seems in the patient's best interest to undergo six to 12 months of such toxic therapy for an average survival extension in the range of a few months.
Further exploration of adjuvant chemotherapy in controlled trials for postmenopausal node-positive women may eventually result in regimens with much larger effect. -- Dr. I. Craig Henderson director, Breast Evaluation Center, Dana-Farber Cancer Institute, Boston; associate professor of medicine, Harvard