Adjuvant chemotherapy--the dark side of clinical trials. Have we learnt more?

The Breast : Official Journal of the European Society of Mastology
Catherine OakmanAngelo Di Leo

Abstract

Large adjuvant trials, over many years, have randomised thousands of women with early breast cancer to different regimens. They have been instrumental in defining our current approach in the adjuvant setting. However in clinical practice with each patient, we still have the difficulty of targeting their specific therapy, as results relating to the average trial population are often not transferable to the individual. This review of adjuvant chemotherapy trials focuses on the heterogeneity of disease, treatment, mechanisms of chemotherapy action and risk. These issues are of key importance in our interpretation and application of results from adjuvant trials. A critical issue in adjuvant chemotherapy is identification of patients at high risk of recurrence who have chemosensitive tumours. Risk of relapse does not always correlate with chemosensitivity, and cytotoxic therapy in patients with chemorefractory disease may be ineffective and associated only with toxicity. Rather than general sensitivity to cytotoxics, we need predictive biomarkers to guide which specific therapy will be effective in a particular patient. Assessment of specific biomarkers as predictive tools may individualise care and see chemotherapy implementation a...Continue Reading

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