Adjuvant therapy of node-negative breast cancer

Evidence Summaries

Level of Evidence = A

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.

References

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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