Adjuvant chemoimmunotherapy with LMF plus BCG in node-negative and node-positive breast cancer - intermediate report at 4 years

Performance of General Hospitals in Delivering Adjuvant Chemotherapy to Breast Cancer Patients

Indications for and modes of delivery of adjuvant chemotherapy in early breast cancer were assessed in a group of 353 patients followed within a cohort of 1110 newly diagnosed cases in 54 Italian general hospitals. Among node-positive patients 79 % pre- and 44 % postmenopausal women had the treatment. Only a few node-negative women (10 % pre- and 5 % post-menopausal) were treated. The multidrug combination CMF was by far the most commonly employed (89 %) in its two types: cCMF (the classic combination where cyclophosphamide is given orally on days 1–14 and the two other drugs i.v. on days 1 and 8 every 28 days for either 6 or 12 cycles) to 33 % women and nCMF (the more recent combination where all three drugs are given i.v. on day 1 every 21 days for 12 cycles) to 63 %. The mode of delivery of treatment was consistent with the Italian National Breast Cancer Task Force (F.O.N. Ca. M.) recommendations for the cCMF combination, but the lack of clear guidelines on the use of nCMF led to wide variations in the total number of cycles administered. At present, however, it is hard to establish whether this will have any impact on patients’ outcome. Overall the study suggests that adjuvant chemotherapy for breast cancer has entered general practice and can be satisfactorily delivered at the community level. However, better guidelines need to specify more precisely the treatment indications (i.e. subgroups with greater expected benefits), regimen type (is nCMF still experimental or already standard?) and treatment duration, in view of the present uncertainty about what should be the standard for general practice. The paper finally discusses the feasibility of the treatment comparing general hospitals’ performance with that achieved in controlled clinical trials of adjuvant chemotherapy.

Immunotherapy of breast cancer: a review of the development of cell-specific therapy

A brief history of immunotherapy for breast cancer is presented, with emphasis on how theories developed as the field of immunology became more sophisticated. Non-specific therapies, such as Bacillus Calmette-Guérin, levamisole, interferon, interleukin, and others are reviewed. A form of cell-specific immunotherapy is then presented, and some current results are summarized. Problems and proposals for the future development of immunotherapy for breast cancer are then presented.

Adjuvant chemotherapy of solid tumors

Adjuvant chemotherapy for microscopic disease following eradication of clinically detectable lesions by primary surgery and/or radiotherapy is of documented benefit for some oncology patients. However, for many primary cancers efficacy is limited to specific subgroups of patients or has demonstrated no advantage over primary therapy alone. The rationale for adjuvant chemotherapy and results of selected trials are reviewed. In patients for whom adjuvant therapy is of demonstrated benefit, further trials aimed at delineation of patient selection factors, optimal chemotherapy regimens and schedules, and duration of therapy are needed; progress in adjuvant treatment of other subgroups may require development of more effective antineoplastic drugs, in addition to exploration of these factors.