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268 Chemo-hormonotherapy of advanced breast cancer: Rationale, clinical review and perspectives
66
COMPARATIVE STUDY OF CHEMOTHERAPY VERSUS HORMONAL THERAPY AS AN ADJUNCT IN THE MANAGEMENT OF EARLY BREAST CANCER. J. Bonte, J.Ph. Janssens, P. Ide, G. Billiet, G. Vlaemynck, B. De Gryse, D. Winoto, J. Schreurs, A. Brouwers and N. Schockaert. Academisch Ziekenhuis St. Rafa@l, Louvain (Belgium) Gynaecologische Gezwelziekten, Early stage I and II breast cancers (Tl-T2, NO-l, MO) basically treated by means of locoregional combined radiosurgical therapy are submitted to a randomized trial for adjuvant therapy comparing polychemotherapy (CMF) with hormone therapy by means (mediumof either anti-estrogens (conventional dosed Nolvadex), either progestogens dosed Provera). The achieved recurrence and survival rates are discussed with special regard to hormone-dependency of the tumours expressed by their cytosol ER and PR content. In that way perspectives are opened to new hormonal approaches of endocrine-related cancers by hormonal manipulations with combined anti-estrogen-progestogen therapy.
!67
VAC
VAC+H.D.
VS.
MPA:
A
RANDOMIZED
MULTINATIONAL
CLINICAL
PellegriniA., Robustellidella Cuna G. (Italia), Farmitalia
Puerto
260 postmenopausal December
B)
are
gimen
evaluable
A and
(P(O.01).
268
Median
86 weeks
(P(O.01) full
doses
was
for
reduced
groups
(chemo and
for
regimen
more
not than
survival regimen
METASTATIC A.
BREAST
(Argentina),
Both
CHEMO-HORMONOTHERAPY
were
not
56%
patients
for
regimen
and
regimens
more
than
we;e
time
for
of for
150 weeks
well
BREAST
following
(bone,
soft
(117
of group
regimen A and
(median
tolerated:
in group
in
alone.
stratifica
tissue,
A and
107
regimen
viscera, of group
B.
With
months
B (P
for
reached)
group
A
Furthermore,
A than
CANCER
'79 and
B) VAC
of the
H.
P.
October
site
for
Funes
Zanon
for
a re _
all the evaluablepatientswas mo-
regimen
) wasobserved.
frequent
between or regimen
A and 47%
CANCER.
Cartes
all the evaluablepatientswas 16
reached)
was more
OF ADVANCED
REVIEW AND PERSPECTIVES, A.Pellegrini,G.Robustelli
on the basis
224
to P of
(WBC<'+OOO/mm
significantly
randomized Acetate
metastatic
Fledian survival
(median
of leucopenia was
were
regi;,lnn A, and 84 weeks
of responders
B (P(O.01).
incidence
of chemotherapy
CR+PR time
B (P(O.01). for
ca.
identified
hormonotherapy).
median
30 months
breast
Medroxyprogesterone
2) dominant
status
tolerance.
reached)
time
metastatic VAC+H.O.
of patients
and/or
of 30 months,
(median
A)
Performance
response
time
8 months
146 weeks
P of responders
and
therapy
for
measurable
regimen
within
1) Karnofsky
observation
than
with
either
was performed
3) previous
median
re
patients
parameters:
mixed)
IN
Luchina
V.
'81 to receive
Randomization tie"
TRIAL
R.,
(Messico), ArraztoaJ. (Cile), Da Silva Neto J.B. (Erasile) Carlo Erba,SpA, Via C. Imbonati 24, 20159 Milano, Italy.
Lira
(Spagna),
Estevez
in group
for a
time
to
regimen
B
regimen
A
significantly
administration
of
B.
: RATIONALE,
CLINICAL
Della Tuna, L.Frati,V.Mascia,B.Massidda.
Farmitalia C, Erba, SpA Via C. Imbonati 24, 20159 Milano, Italy. Hormonal manluolatlon of advanced breast cancer and polichemotherapy already reached a "plateau" of_ response rate, response duration and &era11 survivai. The hbrmonochekind of motherapy has been considered as a more aggressive modality treatment. This treatment appears to be justified by accepted principles in methodology for a correct combined modality approach in solid tumors : a) choice of individually effective drugs (alone or in combination); b) use of compounds with different mechanism of action, diferent spectra of toxicity, absence or irrilevant cumulative side effects. Estrogens, androgens, antiestrogens, progestins have been combined with different polichemotherapy schedule and actually, the main drugs appear to be tamoxifenITAM)and medroxyprogesterone acetate (MPA). Considering the controlled randomized trials both the combinations seems to increase the response rate, but this increase is not paralleled by a statistically significant increase in complete response and overall survival. The simultaneous administration of hormono and chemotherapy may interfere with cell kinetic with a decrease response to phase specific drugs. A survey report of the different tre atments will be considered; moreover the possibility and the rationale of alternated sequential chemo-hormonotherapy will be discussed.
COMPARATIVE STUDY OF CHEMOTHERAPY VERSUS HORMONAL THERAPY AS AN ADJUNCT IN THE MANAGEMENT OF EARLY BREAST CANCER. J. Bonte, J.Ph. Janssens, P. Ide, G. Billiet, G. Vlaemynck, B. De Gryse, D. Winoto, J. Schreurs, A. Brouwers and N. Schockaert. Academisch Ziekenhuis St. Rafa@l, Louvain (Belgium) Gynaecologische Gezwelziekten, Early stage I and II breast cancers (Tl-T2, NO-l, MO) basically treated by means of locoregional combined radiosurgical therapy are submitted to a randomized trial for adjuvant therapy comparing polychemotherapy (CMF) with hormone therapy by means (mediumof either anti-estrogens (conventional dosed Nolvadex), either progestogens dosed Provera). The achieved recurrence and survival rates are discussed with special regard to hormone-dependency of the tumours expressed by their cytosol ER and PR content. In that way perspectives are opened to new hormonal approaches of endocrine-related cancers by hormonal manipulations with combined anti-estrogen-progestogen therapy.
!67
VAC
VAC+H.D.
VS.
MPA:
A
RANDOMIZED
MULTINATIONAL
CLINICAL
PellegriniA., Robustellidella Cuna G. (Italia), Farmitalia
Puerto
260 postmenopausal December
B)
are
gimen
evaluable
A and
(P(O.01).
268
Median
86 weeks
(P(O.01) full
doses
was
for
reduced
groups
(chemo and
for
regimen
more
not than
survival regimen
METASTATIC A.
BREAST
(Argentina),
Both
CHEMO-HORMONOTHERAPY
were
not
56%
patients
for
regimen
and
regimens
more
than
we;e
time
for
of for
150 weeks
well
BREAST
following
(bone,
soft
(117
of group
regimen A and
(median
tolerated:
in group
in
alone.
stratifica
tissue,
A and
107
regimen
viscera, of group
B.
With
months
B (P
for
reached)
group
A
Furthermore,
A than
CANCER
'79 and
B) VAC
of the
H.
P.
October
site
for
Funes
Zanon
for
a re _
all the evaluablepatientswas mo-
regimen
) wasobserved.
frequent
between or regimen
A and 47%
CANCER.
Cartes
all the evaluablepatientswas 16
reached)
was more
OF ADVANCED
REVIEW AND PERSPECTIVES, A.Pellegrini,G.Robustelli
on the basis
224
to P of
(WBC<'+OOO/mm
significantly
randomized Acetate
metastatic
Fledian survival
(median
of leucopenia was
were
regi;,lnn A, and 84 weeks
of responders
B (P(O.01).
incidence
of chemotherapy
CR+PR time
B (P(O.01). for
ca.
identified
hormonotherapy).
median
30 months
breast
Medroxyprogesterone
2) dominant
status
tolerance.
reached)
time
metastatic VAC+H.O.
of patients
and/or
of 30 months,
(median
A)
Performance
response
time
8 months
146 weeks
P of responders
and
therapy
for
measurable
regimen
within
1) Karnofsky
observation
than
with
either
was performed
3) previous
median
re
patients
parameters:
mixed)
IN
Luchina
V.
'81 to receive
Randomization tie"
TRIAL
R.,
(Messico), ArraztoaJ. (Cile), Da Silva Neto J.B. (Erasile) Carlo Erba,SpA, Via C. Imbonati 24, 20159 Milano, Italy.
Lira
(Spagna),
Estevez
in group
for a
time
to
regimen
B
regimen
A
significantly
administration
of
B.
: RATIONALE,
CLINICAL
Della Tuna, L.Frati,V.Mascia,B.Massidda.
Farmitalia C, Erba, SpA Via C. Imbonati 24, 20159 Milano, Italy. Hormonal manluolatlon of advanced breast cancer and polichemotherapy already reached a "plateau" of_ response rate, response duration and &era11 survivai. The hbrmonochekind of motherapy has been considered as a more aggressive modality treatment. This treatment appears to be justified by accepted principles in methodology for a correct combined modality approach in solid tumors : a) choice of individually effective drugs (alone or in combination); b) use of compounds with different mechanism of action, diferent spectra of toxicity, absence or irrilevant cumulative side effects. Estrogens, androgens, antiestrogens, progestins have been combined with different polichemotherapy schedule and actually, the main drugs appear to be tamoxifenITAM)and medroxyprogesterone acetate (MPA). Considering the controlled randomized trials both the combinations seems to increase the response rate, but this increase is not paralleled by a statistically significant increase in complete response and overall survival. The simultaneous administration of hormono and chemotherapy may interfere with cell kinetic with a decrease response to phase specific drugs. A survey report of the different tre atments will be considered; moreover the possibility and the rationale of alternated sequential chemo-hormonotherapy will be discussed.