Adjuvant Chemotherapy of Breast Cancer

H.-J. Senn Adjuvant Chemotherapy (ACT) of breast cancer has now emerged as one of the controversial su):>jects in clinical and also experimental oncology. Driven by growing frustration about stagnating cure rates in breast cancer [1,4] and stimulated by elegant demonstration of highly curative effects of adjuvant systemic therapy in animal models [6, 11] and in several childhood neoplasias [15], researchers introduced ACT to the primary treatment of breast cancer with great hope some 15 years ago. After a first wave of isolated "historic" trials with generally limited but in one case remarkable success [5, 9], a second generation of ACT studies was initiated by NSABP investigators and oncology centers in Europe [2, 6, 13]. These trials were well conducted statistically and diagnostically, and all in the early 1970s included a surgical control arm. Early and intermediate beneficial effects on relapse-free survival (RFS) after 2-3 years median observation time then prompted a whole series of ACT studies in breast cancer. These "third-gener ation" studies usually regarded some positive influence of ACT as a given fact, dropping surgical control regimens and comparing different ACT regimens, hopefully in a prospective, randomized way 1984 Fig. 1. The mushrooming of adjuvant studies in breast cancer XII Introduction [reviews in 3, 14]. The "mushrooming" of ACT studies in breast cancer during the last 10 and especially 5 years is demonstrated in Fig. 1, and it gets really cumbersome even for the insider to keep on top of the multitude of sometimes conflicting data.

Inhalt
Scientific Basis of Adjuvant Chemotherapy in Breast Cancer.- The Preclinical Scientific Basis for Adjuvant Chemotherapy in Breast Cancer.- The Clinical-Scientific Basis of Adjuvant Chemotherapy in Breast Cancer.- Molecular and Cellular Mechanisms Underlying Ineffective Cancer Chemotherapy.- Impact of Early Detection of Breast Cancer on Adjuvant Chemotherapy.- Contribution of Prognostic Factors to Adjuvant Chemotherapy in Breast Cancer.- Review: Scientific Basis of Adjuvant Chemotherapy in Breast Cancer.- Clinical Results I: Experience of Randomized Trials with Surgical Controls.- Scandinavian Trials with a Short Postoperative Course Versus a 12-Cycle Course.- A Brief Overview of Findings from NSABP Trials of Adjuvant Therapy.- CMF Adjuvant Programs at the Milan Cancer Institute.- A Controlled Trial of Adjuvant Chemotherapy with Melphal-an Versus Cyclophosphamide, Methotrexate, and Fluorouracil for Breast Cancer.- Adjuvant Chemoimmunotherapy with LMF + BCG in Node-Negative and Node-Positive Breast Cancer: 8 Year Results.- Ludwig Breast Cancer Trial LBCS III: Chemo-and Endocrine Adjuvant Treatment in Postmenopausal Patients.- Postmenopausal Node-Positive Comparison of Observation with CMFP and CMFP + Tamoxifen Adjuvant Therapy An Eastern Cooperative Oncology Group Trial.- Adjuvant Systemic Therapy in High-Risk Breast Cancer: The Danish Breast Cancer Cooperative Group's Trials of Cyclophosphamide or CMF in Premenopausal and Tamoxifen in Postmenopausal Patients.- Clinical Results II: Experience of Non-Randomized Trials with Historical or Mached Surgical Controls.- FAC + BCG as Adjuvant Therapy in Breast Cancer: An 8-Year Update.- Current Results of the University of Arizona Adjuvant Breast Cancer Trials (19741984).- Significance of Drug Dose, Timing and Radiotherapy inAdjuvant Therapy of Breast Cancer.- The Use of a Natural History Data Base to Compare Outcome Among Several Trials of Adjuvant Chemotherapy for Stage II Breast Cancer.- Clinical Results III: Experience of Randomized Trials Without Surgical Controls.- Adjuvant Systemic Therapy in Postoperative Node-Positive Patients with Breast Carcinoma: The CALGB Trial and the ECOG Premenopausal Trial.- Adjuvant Therapy of Breast Cancer: A Southwest Oncology Group Experience.- Short- or Long-term Chemotherapy for Node-Positive Breast Cancer: LMF 6 Versus 18 Cycles. SAKK Study 27/26.- Adjuvant Programs for Postmenopausal Women with Node-Positive Breast Cancer: Preliminary Analysis of 5-Year Results.- Review: Experience of Randomized Trials Without Surgical Controls.- Remaining Problems of Adjuvant Chemotherapy in Breast Cancer.- Second Malignant Neoplasms in Operable Carcinoma of the Breast.- Tamoxifen and Combination Chemotherapy as Adjuvant Treatment in Postmenopausal Women with Breast Cancer.- Ludwig Breast Cancer Trials LBCS III and IV: Adjuvant Endocrine Treatment in Postmenopausal Patients.- Problems of Combined Adjuvant Radiochemotherapy.- The Present Dilemma of Adjuvant Chemotherapy: Acceptance and Risks Versus Benefits.- Are Current Worldwide Studies Going to Answer the Important Questions Remaining in Adjuvant Chemotherapy of Breast Cancer?.- Closing Remarks and Outlook.- Closing Remarks and Outlook.