Summary
This study tried to evaluate the impact of adjuvant chemotherapy on the induction of chemoresistance in radically operated upon breast cancer patients. Remission rate, remission duration and survival of a group of women (n=22) treated with combination chemotherapy (adriamycin and cyclophosphamide, AC) for recurrent breast cancer after failed adjuvant therapy (cyclophosphamide, methotrexate, fluorouracil, vinblastine) were retrospectively compared with the clinical data of non-pre-treated patients (n=28) receiving the same regimen (AC). The two groups of patients were comparable with regard to their risk factors. In the group of women with prior adjuvant chemotherapy only 3 out of 22 had a partial response, lasting 3, 8, and 16 months; the median survival was 50 months. In the group without prior adjuvant therapy 3 complete and 7 partial remissions with a median remission duration of 15.5 months (range 2–54 months) were found; the median survival was 104 months. The percentage of objective responses among the non-pre-treated patients at 36% was almost significantly higher than that of the pretreated women with 14% (p<0.1). Responders to chemotherapy after relapse profited in terms of survival within the first 3 years after radical mastectomy, although no statistically significant difference was observed. The survival data shown assume a “shifting” of women from a group with better prognosis to a group with unfavourable prognosis following failed adjuvant chemotherapy.
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Bitran JD, Desser RK, Shapiro CM, Michel A, Kozloff MF, Billings AA, Recenty W (1983) Response to secondary therapy in patients with adenocarcinoma of the breast previously treated with adjuvant chemotherapy. Cancer 51:381–384
Bonadonna G, Valagussa P (1985) Adjuvant systemic therapy for resectable breast cancer. J Clin Oncol 3:259–275
Bonadonna G, Brusamolino E, Valagussa P, Rossi A, Brugnatelli L, Brambilla C, Delena M, Tancini G, Bajetta E, Mussomeci R, Veronesi U (1976) Combination chemotherapy as an adjuvant treatment in operable breast cancer. N Engl J Med 294:405–410
Bonadonna G, Valagussa P, Rossi A, Tacini G, Brambilla C, Zambetti M, Voronesi U (1985) Ten-year experience with CMF-based adjuvant chemotherapy in resectable breast cancer. Breast Cancer Res Treat 5:95–115
Buzdar A, Legha S, Hortobagyi G et al. (1981) Management of breast cancer patients failing adjuvant chemotherapy with adriamycin-containing regimens. Cancer 47:2798–2802
Carter SK (1980) Surgery plus adjuvant chemotherapy — a review of therapeutic implications. I. Breast cancer. Cancer Chemother Pharmacol 4:147–163
Clark G, Sledge G, Osborne K, McGuire W (1987) Survival from first recurrence: relative importance of prognostic factors in 1015 breast cancer patients. J Clin Oncol 5:55–61
Chlebowski RT, Weiner JM, Luce J, Hestorff R, Lang JE, Reynolds R, Godfrey T, Ryden VMJ, Bateman JR (1981) Significance of relapse after adjuvant treatment with combination chemotherapy of 5-fluorouracil alone in high risk breast cancer. Cancer Res 41:4399–4403
Chlebowski R, Weiner J, Reynolds R, Luce J, Bulcavage L, Boteman JR (1986) Long-term survival following relapse after 5-FU but not CMF adjuvant breast cancer therapy. Breast Cancer Res Treat 7:23–28
Cutler S, Asire A Taylor S (1969) Classification of patients with disseminated cancer of the breast. Cancer 24:861–869
DeVita VT, Henney JE, Stonehill E (1979) Cancer mortality: the good news. In: Jones SE, Salmon SE (eds) Adjuvant therapy of cancer. II. Grune & Stratton, New York, pp 212–216
Devitt J (1971) The enigmatic behaviour of breast cancer. Cancer 27:12–17
Dixon WJ, Brown MB, Engelmann L, Frane JW, Hill MA, Jennrich RI, Toporek JD (1981) BMDP Statistical Software. University of California Press, Berkeley, Los Angeles, London
Fisher B, Slack NH (1970) Number of lymph nodes examined and the prognosis in breast cancer. Surg Gynecol Obstet 131:79–88
Fisher B, Remond C, Fisher ER, Participating NSABP Investigators (1984) A summary of findings from NSABP trials of adjuvant therapy. In: Jones SE, Salmon SE (eds) Adjuvant therapy of cancer. IV. Grune & Stratton, Orlando, pp 185–194
Hietanen P, Miettinen M, Makinen J (1986) Survival after first recurrence in breast cancer. Eur J Cancer Clin Oncol 22:913–919
Hill GJ (1980) II Adjuvant chemotherapy—a research tool only? Sixty-Sixth Annual Clinical Congress of the American College of Surgeons, Abstract 10:96
Jakesz R, Kolb R, Reiner G, Rainer H, Schemper M, Moser K (1985) Effect of adjuvant chemotherapy in stage I and II breast cancer is dependent on tumor differentiation and estrogen receptor status. Proc ASCO Abstract 4:69
Jones S, Dupre B, Salmon S (1975) Combination chemotherapy with adriamycin and cyclophosphamide for advanced breast cancer. Cancer 36:90–97
Jungi WF (1983) Adjuvant chemotherapy in breast cancer: 1984 opinion. Wien Klin Wochenschr 13:486–492
Kolata G (1985) Breast cancer consensus. Science 229:1378
Leibermann DP, Berstock DA, Haughton J, Kearney G (1979) Oral adjuvant therapy in breast carcinoma — a multicentric trial. Cancer Treat Rev 6:91–96
Leonard R, Soukop M, Harris A (1986) “Controversies in drug resistance” October 23–24. Br J Cancer 53:575–578
Lloyd R, Jones S, Salmon S (1979) Comparative trial of low dose adriamycin plus cyclophosphamide with or without additive hormonal therapy in advanced breast cancer. Cancer 43:60–65
Nagel G (1977) Therapic des metastasierenden Mammakarzinoms. Dtsch Med Wochenschr 102:1823–1827
Nemoto T, Horton J, Simon R Odo T, Rosner D, Cunningham T, Sponzo R, Snyderman M (1982) Comparison of four combination chemotherapy programs in metastatic breast cancer: comparison of multiple drug therapy with cytoxan, 5-FU and prednisone versus cytoxan and 5-FU and adriamycin versus cytoxan, 5-FU and prednisone alternating with cytoxan and adriamycin. Cancer 49:1998–1993
Pater J, Mores D, Loeb M (1981) Survival after recurrence of breast cancer. Can Med Assoc J 124:1591–1595
Polyzos A, Hug V, Hortobagyi G (1986) The chemosensitivity pattern of tumor cells from postmenopausal women is the same as that of premenopausal women. Proc AACR 27:1532
Queißer W (1980) Adjuvante Chemotherapie des Mammakarzinoms. Fortsch Med 98:286–288
Rossi A, Bonadonna G, Valagussa P, Bonfi A, Veronesi U (1980) CMF adjuvant program for breast cancer: five year results. Proc ASCO 21:404
Senn HJ, Mayr AC (1979) Adjuvant chemotherapy in breast cancer-Swiss cooperative studies. Cancer Treat Rev 6:79–85
Tancini G, Bonadonna G, Valagussa P, Marchini S, Veronesi U (1983) Adjuvant CMF in breast cancer: comparative 5 year results of 12 versus 6 cycles. Clin Oncol 1:2–10
Tranum B, McDonald B, Thigpen T, Vaughn C, Wilson H, Maloney T, Costanzi J, Bickers J, el Mawli N, Palmer R, Hoogstraten B, Heilburn L, Rasmussen S (1982) Adriamycin combination in advanced breast cancer. A Southwest Oncology Group Study. Cancer 49:835–839
Valagussa P, Rossi A, Tancini G, Bonadonna G (1985) Is there any effective salvage treatment for relapsing operable breast cancer with N+? Proc ASCO 4:56
Valagussa P, Tancini G, Bonadonna G (1986) Salvage treatment of patients suffering relapse after adjuvant CMF chemotherapy. Cancer 58:1411–1417
WHO Handbook für Reporting Results of Cancer Treatment (1979) WHO offset Publication, Geneva, World Health Organization 48
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Dittrich, C., Jakesz, R., Pirich, K. et al. Possible adverse effect of failed adjuvant chemotherapy on the prognosis of women receiving consecutive chemotherapy for recurrent breast cancer. J Cancer Res Clin Oncol 113, 488–494 (1987). https://doi.org/10.1007/BF00390044
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DOI: https://doi.org/10.1007/BF00390044