Short Chemo Intervals Cut Breast Cancer Recurrence

[Guest guest]

Short Chemo Intervals Cut Breast Cancer Recurrence

By a Moyer

NEW YORK (Reuters Health) - Shortening the interval between

chemotherapy treatments may help reduce the risk of breast cancer

recurrence, according to a New York researcher who is to report the

findings Thursday at the annual San Breast Cancer Symposium.

What's more, when chemotherapy agents are given sequentially,

patients experience less toxicity than when the drugs are given in

combination. Adding a white blood cell stimulator to the mix helps

prevent hospitalizations due to neutropenia, a condition

characterized by a drop in infection-fighting white blood cells that

can occur with frequent chemotherapy, said Dr. Marc Citron, a

clinical professor of medicine at Albert Einstein College of

Medicine in New York City.

" For patients with breast cancer, frequency of dosing is an

important area of research now, " Citron told Reuters Health. A new

generation of breast cancer studies is looking at a more closely

spaced regimen, known as the " dose-dense " approach, he said. If the

results are confirmed, they may become more available to patients.

" More frequent dosing will be a treatment option for some patients.

It is not yet the standard of care for patients with node-positive

breast cancer, but it is an option that will be discussed with

patients after these study results are released, " Citron said.

In the study, Citron and colleagues followed 2,005 breast cancer

patients who had undergone surgery, either lumpectomy or mastectomy,

along with lymph node removal. All the women had cancer that had

spread to the lymph nodes, a situation that often calls for

chemotherapy.

The study had two aims: to see if shortening the interval between

chemotherapy treatments helped reduce breast cancer recurrence, and

to see if sequential chemotherapy was associated with less toxicity

than combination chemotherapy.

Patients were randomly assigned to one of four treatment arms. Some

patients were on a two-week cycle (the dose-dense group) while

others received treatment on a three-week cycle. In addition, some

patients took one drug during a cycle and then switched for the next

cycle (the sequential group), while others took combinations of

drugs.

In the dose-dense arms, patients also received treatment with a

genetically engineered version of granulocyte colony-stimulating

factor, called filgrastim, which stimulates white blood cell

regeneration.

The researchers found that dose-dense treatment was associated with

a 26% reduction in the risk of recurrence and a 31% improvement in

survival.

" Disease-free survival was 82% in the dose-dense arms, and 75% in

the conventional arms, " Citron told Reuters Health. " There was no

difference in the efficacy of concurrent treatment versus sequential

treatment, but sequential treatment was less toxic. " Dose-dense

treatment was also associated with fewer hospitalizations for

neutropenia, an outcome Citron attributed to treatment with the

white blood cell-boosting drug.

In the combination dose-dense arm, 13% of patients received

transfusions of red blood cells, compared to less than 4% in the

other arms.

" This outcome surprised me, because there are medications to

stimulate red blood cells, " he said. " However, in my own practice we

haven't had any transfusions. " The transfusion rate may be related

to insurance issues, he said, noting that some insurance companies

do not cover red blood cell-boosting treatment unless hemoglobin--

the oxygen-carrying component of blood--falls to a certain level.

The study was funded by the National Cancer Institute (NCI) and

Amgen, a company that makes the white blood cell-boosting drug. Some

of the researchers were from Memorial Sloan-Kettering Cancer Center,

which discovered and licenses the drug to Amgen.

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