Chemotherapy improves disease-free survival in both premenopausal and postmenopausal patients with estrogen-receptor negative tumours, and increases overall survival in this postmenopausal group, and in the premenopausal group with tumours 3 cm or larger. Tamoxifen appears to increase disease-free survival, and definitely decreases contra-lateral primary breast cancer in women with estrogen-receptor positive tumours.
A systematic review 1 including 10 RCTs (6 trials comparing cytotoxic chemotherapy with no adjuvant therapy (n=3191), 3 trials comparing tamoxifen with no therapy (n=4196), 1 trial comparing several treatments) was abstracted in DARE.
Two of the 6 trials on cytotoxic chemotherapy found no significant difference, whereas 4 trials did. The treatment group had a significantly better overall survival in two trials.
The 3 trials with tamoxifen vs. placebo all reported better disease free survival and overall survival in the treatment groups. No p values were given for one trial. In the other 2 trials, only the difference in disease free survival was statistically significant. Meta-analysis from Early Breast Cancer Trialists´ Collaborative Group: disease free survival at 10 years was 68.1% for tamoxifen and 63.1% for control, and 61.5% for polychemotherapy and 54.5% for control.
1. Hall PD, Lesher BA, Hall RK. Adjuvant therapy of node-negative breast cancer. Ann Pharmacother 1995 Mar;29(3):289-98. [PMID:7606076]
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Adjuvant therapy of node-negative breast cancer. Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. https://evidence.unboundmedicine.com/evidence/view/EBMG/456834/all/Adjuvant_therapy_of_node_negative_breast_cancer. Accessed October 31, 2020.
Adjuvant therapy of node-negative breast cancer. (2019). In Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited. Retrieved October 31, 2020, from https://evidence.unboundmedicine.com/evidence/view/EBMG/456834/all/Adjuvant_therapy_of_node_negative_breast_cancer
Adjuvant Therapy of Node-negative Breast Cancer [Internet]. In: Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. [cited 2020 October 31]. Available from: https://evidence.unboundmedicine.com/evidence/view/EBMG/456834/all/Adjuvant_therapy_of_node_negative_breast_cancer.
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