Quality-of-life-adjusted evaluation of adjuvant therapies for operable breast cancer

Article Abstract:

Breast cancer is essentially a different disease in premenopausal and postmenopausal women. Premenopausal women whose cancer is detectable in their lymph nodes (positive nodes) are known to have greater periods of disease-free survival if they are given six months of adjuvant (after surgery) chemotherapy with a multi-drug regimen. Postmenopausal women with positive nodes do better with tamoxifen, an estrogen-like drug, or combinations of tamoxifen and chemotherapy. Whether there is overlap between the groups and the treatments remains controversial. A distinction exists between disease-free survival period and total survival time, and questions are raised whether longer disease-free periods without greater overall survival can justify the use of chemotherapy regimens which may adversely affect the quality of life of the patients treated. The International Breast Cancer Study Group has been comparing the use of a single course of chemotherapy at the time of mastectomy to a prolonged course (six or seven cycles of drugs) of adjuvant chemotherapy in women with positive lymph nodes. Preliminary results (at 42 months) showed that disease-free survival was improved significantly with the longer course of chemotherapy, but that overall survival was barely improved. Sixty-month follow-up data are now available, and show that both disease-free survival and total survival are improved with prolonged chemotherapy in premenopausal patients. The postmenopausal patients had less improvement, thus prompting the investigators to consider whether quality of life issues might sway a decision about prolonged chemotherapy in this group of breast cancer patients. By using graphs to plot the times of treatment toxicity, times without symptoms or toxicity, and times of relapse of disease, comparisons were made among patients in various subgroups with different treatments. Although overall survival in postmenopausal women was not improved with prolonged chemotherapy, time without symptoms and toxicity was improved, thus suggesting that the quality of life was improved, and that these patients, too, might benefit from prolonged chemotherapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Drug therapy, Breast cancer, Quality of life, Dosage and administration, Chemotherapy, Tamoxifen

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Monoclonal antibodies for treating cancer

Article Abstract:

Effective cancer treatment is hindered by the many different cancer cell types found in tumors. Antibodies, which are normally created by the immune system to attack cancer cells, are specific to tumors. Modern technology has developed a way to produce large amounts of identical antibodies, monoclonal antibodies, in the laboratory to be reintroduced into the body as a cancer treatment. To assess the use of monoclonal antibodies in the treatment of cancer, 235 relevant articles written on the subject were reviewed. Monoclonal antibodies can be used alone or in combination with agents known to destroy cancer cells. Mouse antibodies are selected based on their ability to react against the patient's particular cancer. Injected antimouse antibodies cause human antimouse antibodies to be produced. Therefore, the human antimouse antibodies induce the production of antibodies with the same tumor-fighting qualities as the original mouse antibody. However, until methods to eliminate the original mouse antibodies are found, the method is problematic. Monoclonal antibodies labeled with radioactive markers have proved that these antibodies are directed towards tumor cells. However, because tumor cells are not all alike and are difficult to destroy, success has been limited. The most promising use of monoclonal antibodies involves immunoconjugates, antibodies directed at receptors on the immune system's fighting T-cell. The cells are activated to produce a toxic state so they will kill. These conjugates, however, are difficult to produce in large therapeutic quantities. The use of monoclonal antibodies as a treatment for cancer is still in its initial stages. Although progress appears slow, the issues surrounding monoclonal antibodies are complex. The use of monoclonal antibodies in cancer treatment continues to be promising. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Antineoplastic agents

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Mycosis fungoides arthropathy

Article Abstract:

Mycosis fungoides is a form of lymphoma that involves invasion of the skin by malignant cells. A case is reported in which the malignant cells of mycosis fungoides invaded joints as well. A 39-year-old woman developed a rash on her abdomen and then her limbs. Two years later, she developed arthritis, and neither her rash nor her joint symptoms responded to conventional therapy. A skin biopsy demonstrated typical findings of mycosis fungoides. Over the following five years, the patient's mycosis fungoides was treated with various regimens which provided temporary improvement to her skin lesions, but not to her joint symptoms. Fluid removed from her knee contained cells that were consistent with mycosis fungoides. She was treated with the new agents known as monoclonal antibodies, and skin and joint symptoms were then evaluated. She tolerated the therapy, and experienced a substantial decrease in skin involvement, but while her joint fluid showed decreased numbers of mycosis fungoides cells, her perception of her joint disease was that it was unchanged. Long-term remission was not achieved. However, monoclonal antibodies may offer promise in mycosis fungoides and should be further investigated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Complications and side effects, Joint diseases, Mycosis fungoides

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