As clinicians, we are all aware of the continuing health threat posed by breast cancer.
An estimated 180,200 new breast cancer cases will be diagnosed in 1997, which will account
for approximately 30% of all new cancer cases in women.1 In addition, breast
cancer is expected to be responsible for 43,900 deaths, or 17% of all female cancer
deaths.1 Although the overall breast cancer mortality rate has been declining
since 1989, the five-year relative survival rate for women with metastatic disease is only
21%.1 These statistics underscore the need for continued pursuit, in both the
laboratory and the clinic, of new and better treatments for breast cancer.
Early in 1997, Moffitt Cancer Center invited five experts in a variety of breast cancer
disciplines to discuss and debate current controversies surrounding breast cancer
treatment. Douglas Reintgen, MD, professor of surgery and program leader of Moffitt's
Cutaneous Oncology Program, described the use of the lymphatic mapping and sentinel node
biopsy techniques in patients with primary breast cancer. Although these techniques are a
standard of care for staging patients with malignant melanoma, their use in breast cancer
remains investigational.
George Sledge, MD, professor of oncology and director of the Breast Cancer Clinic,
Indiana University Medical Center, discussed the uncertainty regarding the duration of
adjuvant tamoxifen therapy in women with breast cancer. A number of studies were recently
reported regarding duration of tamoxifen adjuvant therapy in node-negative women; however,
a consensus on duration has not yet been reached. Few data are available on the value of
tamoxifen in node-positive women.
William Vaughan, MD, professor of medicine and director of the Bone Marrow
Transplantation Program, University of Alabama-Birmingham, described the current
controversies surrounding high-dose chemotherapy and stem cell transplant in metastatic
breast cancer. Although the number of transplants for metastatic breast cancer continues
to increase in the United States, much remains unknown about this treatment, including
which women are most likely to benefit, optimal drug regimens, and the timing of
transplant in relation to other treatment modalities such as radiation, surgery, or
chemotherapy.
Gabriel Hortobagyi, MD, professor of medicine and chairman of the Department of Breast
Medical Oncology, The University of Texas M.D. Anderson Cancer Center, reviewed his
center's analysis of an extensive database on women with metastatic breast cancer who
received combination chemotherapy and maintained a complete remission for longer than five
years. It is encouraging to note that a small percentage of women continue in unmaintained
complete remission over many years; however, there is much room for improvement.
Eric Rowinsky, MD, director of Clinical Research, Cancer Therapy and Research Center,
Institute for Drug Development, The University of Texas Health Science Center at San
Antonio, discussed with Drs Sledge and Hortobagyi the evolving roles of the taxanes in
metastatic disease. These agents, paclitaxel and docetaxel, represent an exciting new
class of antineoplastic agents that are approved for single-agent use and are undergoing
extensive evaluation as components of combination regimens for previously untreated and
previously treated metastatic breast cancer.
Drs Rowinsky, Sledge, and Hortobagyi also briefly reviewed new and promising
antineoplastic drugs, biologics, and other treatment approaches under investigation for
breast cancer. The growing list of agents includes the topoisomerase inhibitors, new
antifolates, liposomal delivery systems, biologic agents, angiogenesis inhibitors, topical
agents, vaccines, aromatase inhibitors, hormonal therapy, and palliative therapies.
Much remains unknown regarding the biology and treatment of breast cancer. However, it
is encouraging that so much progress has been made in this field in the past few years. An
open discussion of controversial treatment issues is valuable because it requires
clinicians and researchers to carefully examine available data and to identify promising
areas for further evaluation.
John Horton, MB, ChB, FACP
Professor of Medicine
Associate Dean, Education
Editor, Cancer Control
University of South Florida
H. Lee Moffitt Cancer Center & Research Institute
Tampa, Florida
Reference
- Parker SL, Tong T, Bolden S, et al. Cancer statistics, 1997. CA Cancer J Clin.
1997;47:5-27.
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Journal Supplement Volume 4 Number 3