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Executive Summary

BREAST CANCER RELAPSE-FREE, OVERALL SURVIVAL IMPROVED by postoperative adjuvant chemotherapy directed at that causes ovarian suppression, according to an article in the Aug. 23 issue of The Lancet. "Adjuvant chemotherapy with cyclophosphamide, methotrexate, and fluorouracil (CMF) in early breast cancer prolongs relapse-free survival and overall survival in premenopausal patients but has only a slight effect in postmenopausal patients," the article states. Authors N. Padmanabhan et al concluded that their findings "support the hypothesis that the effect of adjuvant chemotherapy in early breast cancer may be mediated by ovarian suppression." CMF's therapeutic effects were seen "only when CMF induced permanent amenorrhea in premenopausal patients," they said. Relapse-free and overall survival rates were improved "predominantly in premenopausal patients; these effects were seen only with tumors positive for steroid receptors, particularly progesterone," the report states. "Chemotherapy led to permanent amenorrhea in 61% of premenopausal patients." The authors attempted to establish the extent to which adjuvant chemotherapy effects are mediated by ovarian suppression, and the relationship of survival rates to estrogen receptor and progesterone receptor content in tumors. The report is based on an analysis of 411 patients who had early breast cancer and were randomized to receive either postoperative adjuvant CMF in 12 courses or no additional postoperative treatment. The steroid receptor status of all 411 patients was known; 51 additional patients with unknown receptor status were excluded, the article notes. "Patients treated with CMF had significantly longer relapse-free but not overall survival than controls," although "there was no difference in either relapse-free survival or overall survival in postmenopausal patients," the authors reported. In premenopausal patients relapse-free survival was significantly longer, but although overall survival was longer in the CMF group, it was not significantly longer. "Premenopausal patients with CMF-induced amenorrhea had significantly longer relapse-free (p=0.001) and overall survival (p=0.01) than controls, but the differences between CMF-treated patients who did not become amenorrhoeic and controls were not significant," the authors said. Furthermore, "the differences between CMF-treated patients with and without amenorrhea in relapse-free (p=0.02) and overall survival (p=0.01) were significant."

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