Interrupted versus continuous chemotherapy in patients with metastatic breast cancer

Article Abstract:

In breast cancer, as in most cancers, the most serious complication involves the ability of the cancer cells to spread through the body and grow as secondary cancers in organs distant from the primary cancer. Metastatic breast cancer is essentially incurable, and once breast cancer has reached this stage, chemotherapeutic treatment is administered for the palliation of symptoms, rather than with hopes of increasing survival. It is not certain, however, what the optimal type of chemotherapeutic treatment might be under these circumstances. Many patients with advanced breast cancer are given chemotherapy continuously, but research on some other forms of cancer has indicated that interrupted chemotherapy may be equally effective for relieving symptoms. Since chemotherapeutic treatment itself has serious side effects, it is important to determine if the patient is, indeed, achieving some advantage from such an unpleasant regimen. This question was examined in the course of treating 250 women with metastatic breast cancer. All women received six courses of chemotherapy with cyclophosphamide, doxorubicin, and fluorouracil. Women with either disease regression or disease stabilization were then randomly assigned to receive either continued treatment (with cyclophosphamide, methotrexate, and fluorouracil) or simply be observed. The group who were observed were administered more chemotherapeutic treatment only after signs of disease progression were noted. The patients who received continuous maintenance chemotherapy experienced disease progression after a median of 9.4 months. This was significantly longer than the median 3.2 months to disease progression among the observed group. However, the overall survival rates were not significantly different between the two groups of women, at 21 and 20 months for the maintenance and observed groups, respectively. These results are important considerations to include when counselling patients with advanced breast cancer. For a woman who achieves a reduction of symptoms, continued chemotherapeutic treatment may extend the period of symptom palliation. Conversely, a woman who achieves little benefit or finds the chemotherapeutic treatment especially unpleasant may be advised that discontinuing treatment is unlikely to have any adverse effect on survival. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cancer metastasis

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A comparison of treatment outcomes for black patients and white patients with metastatic breast cancer: the Piedmont Oncology Association experience

Article Abstract:

Black patients consistently have poorer survival rates than white patients for a number of different cancers. This is true for uterine cancer, bladder cancer, colorectal cancer, prostate cancer, kidney cancer, and breast cancer, as well as others. Many explanations have been proffered to account for this disparity in survival. There is some indication that black patients are generally diagnosed less quickly and therefore are more likely to have advanced disease at the time of diagnosis. However, when only patients with the same stage of disease are compared, whites still have a survival advantage over black patients. Some research has indicated that white patients enjoy better medical care, but in at least some studies, no differences have been found between the care received by black and white patients which could account for the survival advantage of whites. A study was undertaken to determine if there were significant differences between the treatment received by black patients and that received by white patients for advanced breast cancer. The case histories of 74 black patients with advanced breast cancer were compared with the case histories of 74 randomly chosen white patients similarly treated during the same period of time. While patients were, in general, matched for the characteristics of their disease, white patients tended to have more metastatic spread of cancer to their bones and less spread to their skin than black patients. Curiously, the researchers found that information was more likely to be missing from the case records of black patients than white patients. The study could not identify any significant differences in the pattern of treatment between the two patient groups, however. After adjusting for other variables that affect the outcome of cancer, the white patients had a median survival time of 20.3 months while the median survival of the black patients was only 14.3 months. The difference in survival appears to be related to differences in the natural history of the disease in the two different groups, and not to clear-cut differences in treatment. The present study did not, however, evaluate the possible impact of socioeconomic factors on the survival of patients with advanced breast cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects, Cancer

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A phase II trial of high-dose cytarabine and cisplatin in previously untreated non-small cell carcinoma of the lung: a Piedmont Oncology Association study

Article Abstract:

Cisplatin is often the drug of choice in the treatment of non-small cell lung cancer. Reports of response rates range from 0 to 45 percent; about 20 percent is the average. Unfortunately, the toxicity of cisplatin for the kidney, ear, and nervous system limits the dose which can be given to a patient. Therefore, cisplatin is commonly used in combination with other chemotherapeutic agents. The effectiveness of cisplatin and cytarabine was evaluated in the treatment of 37 patients with advanced non-small cell lung cancer. The patients had not been treated previously with chemotherapy, but all had advanced disease, which had metastasized (spread) or was not amenable to surgery. An overall response rate of 14 percent was observed. Twelve patients had severe myelotoxicity, indicated by fewer than 1,000 white blood cells per microliter. The severity of myelotoxicity suggested that cisplatin and cytarabine had a synergistic effect in producing this toxic reaction. Unfortunately, the synergism did not carry over to produce a significant therapeutic effect. While the cisplatin-cytarabine combination may be effective for cancers with cytarabine sensitivity, there is no indication that this chemotherapy combination is worthy of further investigation in the treatment of non-small cell carcinoma of the lungs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Complications and side effects, Lung cancer, Non-small cell, Non-small cell lung cancer, Chemotherapy, Combination, Combination chemotherapy, Cisplatin, Cytarabine

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