How to Succeed With Breast Ca... Video Transcript

Participants

, Renee Kemp , Hope S. Rugo MD, Carol L. Kornmehl MD, FACRO

Summary

Adjuvant therapy is usually required in the treatment of breast cancer. It can prevent the cancer from spreading to other parts of the body and thus significantly increase a patient's chances for cure and long-term survival. Join Dr. Hope Rugo as she discusses the latest developments in adjuvant therapy, and how it is improving success rates in breast cancer treatment.

Webcast Transcript

RENEE KEMP: Welcome to our webcast. I'm Renee Kemp. As with other cancers, the greatest risk of breast cancer is that it will spread to other vital organs. Adjuvant therapies can stop this from happening. And today, we'll learn what can be done to increase the effectiveness of these treatments. Joining me is Dr. Hope Rugo. She is the Associate Clinical Professor of Medicine at the UCSF Comprehensive Cancer Center. Thank you for joining us.

Various professional bodies including the NIH currently recommend adjuvant therapy that includes an anthracycline. Why is that?

HOPE RUGO, MD: Review of a number of randomized clinical trials done in the world have been reviewed by an organization called the Early Breast Cancer Trialist Group. They have shown recently that recurrence rates are reduced and survival is improved when anthracycline-based chemotherapy is used, specifically for women whose breast cancer has spread to the nodes under their arm, the axillary lymph nodes.

RENEE KEMP: Of the two anthracyclines that are on the market, doxorubicin, which is commonly known as Adriamycin, and epirubicin, which is commonly known as Ellence, does it matter which one is used?

HOPE RUGO, MD: Right now we don't know that it matters which drug they use. It does appear that epirubicin has less toxicity to the heart than doxorubicin so that you can give a higher dose and worry less.

For example, by the end of six cycles of an epirubicin-containing treatment, you're still far away from a dose that might cause heart weakness. But with six cycles of doxorubicin you're pretty much at your lifetime limit.

In addition, there have been studies which have shown that using the higher dose of epirubicin may be more effective than a lower dose and the same has not been shown for doxorubicin. In other words, studies, which increase the dose of doxorubicin, showed more side effects but no additional benefits in terms of reducing the risk of recurrence of breast cancer.

A recent study showed that if your increase the dose of epirubicin, you actually reduce the risk of recurrence compared to a lower dose of the same drug.

RENEE KEMP: Can you talk a bit about the effectiveness of anthracyclines, particularly epirubicin, in the early stage cancers and in metastatic breast cancers?

HOPE RUGO, MD: When we're treating early stage breast cancers, that would be breast cancer that is either large or has spread to under -- the nodes under the arm -- we're trying to cure the patient. We don't want the cancer to ever come back. So we're willing to take a certain amount of side effects in that situation because the side effects are going to be short-lived. And if you're cured, it would be worthwhile. So in that situation we're going to use perhaps four or six courses of chemotherapy, including an anthracycline, that might last three or four months.

In the metastatic disease setting, what you're trying to do is palliate. In other words, you're trying to help a woman live longer and have better quality of life. So in that situation, we really have to weigh using anthracyclines and when we use them, since they may have a little bit more side effects than some other drug. You want their use to be very judiciously considered before we give somebody a high dose of chemotherapy.

RENEE KEMP: How do you select between the two?

HOPE RUGO, MD: It's very difficult right now. We don't know the right treatment program so we don't have data which has compared all the treatments we have available in all the different subsets of breast cancer.