Montclair Breast Center

Science Letter, June 9, 2006

Breast Cancer; Studies from the United Kingdom, Canada and Italy add new findings to breast cancer body of knowledge

2006 JUN 9 - (NewsRx.com) -- New findings from the United Kingdom, Canada and Italy describe advances in breast cancer.

Study 1: Breast cancer therapy does not appear to affect cognitive function in women.

"The neuropsychological performance of 85 women with early stage breast cancer scheduled for chemotherapy, 43 women scheduled for endocrine therapy and/ or radiotherapy and 49 healthy control subjects was assessed at baseline (T1), postchemotherapy (or 6 months) (T2) and at 18 months (T3)," reported scientists in England.

"Repeated measures analysis found no significant interactions or main effect of group after controlling for age and intelligence," noted V. Jenkins and colleagues of the University of Sussex. "Using a calculation to examine performance at an individual level, reliable decline on multiple tasks was seen in 20% of chemotherapy patients, 26% of nonchemotherapy patients and 18% of controls at T2 (18%, 14 and 11%, respectively, at T3). Patients who had experienced a treatment-induced menopause were more likely to show reliable decline on multiple measures at T2 (OR=2.6, 95% confidence interval (CI) 0.823 -8.266 p=0.086)."

"Psychological distress, quality of life measures and self-reported cognitive failures did not impact on objective tests of cognitive function, but were significantly associated with each other," they determined.

The researchers concluded, "The results show that a few women experienced objective measurable change in their concentration and memory following standard adjuvant therapy, but the majority were either unaffected or even improve over time."

Jenkins and colleagues published the results of their research in the British Journal of Cancer (A 3-year prospective study of the effects of adjuvant treatments on cognition in women with early stage breast cancer. Br J Cancer, 2006;94(6):828-834).

For additional information, contact V. Jenkins, University of Sussex, Cancer Research United Kingdom Psychosocial Oncology Group, Brighton & Sussex Medical School, Brighton BN1 9QG, E Sussex, England. val@sussex.ac.uk.

Study 2: A recent study showed that many chemotherapy side effects improve over time, but not by the addition of hormone therapy.

According to scientists in Canada, "We previously evaluated fatigue, menopausal symptoms, and cognitive dysfunction in patients receiving adjuvant therapy for breast cancer and matched healthy women. We [now] report assessment of these women 1 and 2-years later."

H.G. Fan and colleagues wrote, "Patients without relapse and controls were evaluated by the Functional Assessment of Cancer Treatment-General Quality of Life questionnaire, with subscales for fatigue and endocrine symptoms, and by the High Sensitivity Cognitive Screen. There were 104, 91, and 83 patients and 102, 81, and 81 controls assessed at baseline and at 1 and 2 years, respectively."

The researchers reported, "Median Functional Assessment of Cancer Treatment-Fatigue scores (range, 0 to 52) for patients improved from 31 (on chemotherapy) to 43 and 45 at 1 and 2 years, respectively, but were stable in controls (46 to 48). Median Functional Assessment of Cancer Treatment-Endocrine Symptoms scores (range, 0 to 72) for patients improved from 57 (on chemotherapy) to 59 and 61 at 1 and 2 years, respectively, and were stable in controls (64 to 65)."

"Differences between patients and controls remained significant for these scales. The incidence of moderate-severe cognitive dysfunction by the High Sensitivity Cognitive Screen decreased in patients from 16% (on chemotherapy) to 4.4% and 3.8% and in controls from 5% to 3.6% and 0% at 1 and 2 years, respectively. There were minimal differences between estrogen receptor-positive patients who started hormonal therapy (mainly tamoxifen) after chemotherapy and estrogen receptor-negative patients who did not."

The study group concluded, "Differences in quality of life between patients and controls were significant only at baseline. Fatigue, menopausal symptoms, and cognitive dysfunction are important adverse effects of chemotherapy that improve in most patients. Hormonal treatment has minimal impact on them."

Fan and colleagues published their study in the Journal of Clinical Oncology (Fatigue, menopausal symptoms, and cognitive function in women after adjuvant chemotherapy for breast cancer: 1-and 2-year follow-up of a prospective controlled study. J Clin Oncol, 2005;23(31):8025-8032).

For more information, contact I.F. Tannock, Department of Medical Oncology, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada. ian.tannock@uhn.on.ca.

Study 3: Controversies in adjuvant and neoadjuvant therapies for breast cancer were reviewed in a recent article published in Expert Opinion on Pharmacotherapy.

"Initial randomized studies of chemotherapy and endocrine therapy showed that systemic treatments had a substantial impact on the survival of women with early breast cancer," stated scientists in Italy. "The original assumption was that the efficacy of these treatments was limited to those patients presenting with more adverse prognostic features."

"Subsequently, meta-analyses of randomized trials revealed that the benefits of chemotherapy and endocrine therapy are not mutually exclusive and extend to all the prognostic subgroups," wrote F. Montemurro and colleagues. "However, the absolute benefit varies according to baseline characteristics such as tumor stage and other biological factors."

The authors continued, "Over the last 10 years, considerable progress has been made with the introduction of new drugs into the adjuvant and neoadjuvant treatment of women with breast cancer. Taxanes and third-generation aromatase inhibitors are providing proof of additional benefits compared with standard reference treatments. In parallel, research on the biology of breast cancer is establishing novel prognostic and predictive factors, which may allow better treatment tailoring. Currently, however, women with early breast cancer and their doctors face the difficult task of making therapeutic decisions often based on early results from positive studies. in a disease where follow up is crucial to fully assess the benefit and long-term toxicities of an intervention, current knowledge leaves unanswered questions that generate debate and controversy."

The researchers summarize in this review "recent results from randomized trials of adjuvant and neoadjuvant therapy in women with early breast cancer and focus on the current controversies."

Montemurro and colleagues published their study in Expert Opinion on Pharmacotherapy (Controversies in breast cancer: adjuvant and neoadjuvant therapy. Expert Opin Pharmacother, 2005;6(7):1055-1072).

For additional information, contact F. Montemurro, Institute for Cancer Research and Treatment, IRCC Candiolo, Strada Provinciale 142, 10060 Candiolo, Turin, Italy. fmontemurro@ircc.mauriziano.it.

Keywords: Candiolo, Italy, Breast Cancer, Breast Carcinoma, Chemotherapy, Endocrine Therapy, Neoadjuvant Therapy, Adjuvant Therapy, Aromatase Inhibitors, Taxanes, Women's Health.