Which Adjuvant Therapy is Rig... Video Transcript

Participants

, William J. Gradishar MD, Carol L. Kornmehl MD, FACRO

Summary

Adjuvant therapy, which is used to treat the spread of cancer beyond the breast, is recommended for most breast cancer patients. There are several types of adjuvant therapy, and the best one for you depends on a number of factors, from your age to the size of your tumor. Join Dr. William Gradishar as he discusses how this therapy is tailored for individual patients.

Webcast Transcript

VAREN BLACK: Hi, I'm Veran Black, and welcome to our webcast.

Adjuvant therapy for breast cancer -- which is used to treat the spread of cancer beyond the breast -- is recommended for many breast-cancer patients. But the type of therapy you get depends on a number of factors, including your age and the size of the tumor.

Today we'll be discussing how this therapy is tailored for individual patients. Joining me today is Dr. William Gradishar, director of breast medical oncology and Northwestern Memorial Hospital. Thank you for being with us today.

WILLIAM GRADISHAR, MD: Oh, I'm happy to be here.

VAREN BLACK: Doctor, what are some of the considerations that influence adjuvant treatment?

WILLIAM GRADISHAR, MD: When we see a patient who has a diagnosis of early-stage breast cancer, we take into account the patient's age, we look at the menopausal status of the patient and whether she's a younger or older patient. We take into account certain characteristics related to the tumor as well, and that may include the size of the tumor, whether the lymph nodes are involved. Whether the tumor expresses what's referred to as "estrogen or progesterone receptors."

So all of these things -- both clinical as well as patient features -- go into our decision regarding whether or not that given patient is an appropriate candidate for adjuvant therapy.

VAREN BLACK: Doctor, what about nodal involvement?

WILLIAM GRADISHAR, MD: Nodal involvement's one of the critical -- in a sense -- demarcation points between low- and high-risk. If you look at all patients who are lymph-node negative, the majority of those patients are cured of their disease by local therapy alone -- meaning mastectomy or lumpectomy plus radiation therapy.

On the other hand, once lymph nodes are involved under the arm, it implies -- by definition -- that the tumor has already gone from the breast into the lymph nodes, demonstrating an ability to spread. So as the number of lymph nodes increases from one to three to five to ten, the tumor burden increases, and the probability that there could be disease somewhere else in the body increases. So those are women with positive lymph nodes and more of them as they accumulate more lymph nodes, the risk of recurrence is elevated as well.

VAREN BLACK: Why does adjuvant therapy involve a combination of several drugs?

WILLIAM GRADISHAR, MD: The adjuvant therapy approach that we use has been arrived at through a process of clinical trials. And in the earliest days of adjuvant therapy, single drugs were administered, and then as more drugs became available -- that is, anti-cancer drugs -- we looked at combining them. And what was determined from that process was that combinations of drugs that did not behave in exactly the same way against the cancer cell had an advantage.

So, in other words, making a recipe of drugs was superior to single agents. And when we say superior, it means that when these recipes were tested in large populations of women with early-stage breast cancer, they clearly decreased the risk of recurrence and improved survival. So it's through that process of testing these different recipes that we come to what we refer to as the standard drug combinations used today.

VAREN BLACK: What determines the best combination of drugs for adjuvant therapy?

WILLIAM GRADISHAR, MD: Well, there are a couple of issues that come into play when we make that decision. The first is, we look at the patient and we take into account the patient's age. We take into account whether or not she is able to tolerate chemotherapy, and there might be some distinctions between the recipes in terms of side effects that might be expected.