Recent Advances In Adjuvant Systemic Treatment for Breast Cancer: All Systems Go!

Breast cancer is the most common life-threatening malignancy in Western women, and the second-most common cause of cancer-related death. Estimates suggest that, in 2006, 22,185 Canadian women will be diagnosed with breast cancer and 5277 will die of the disease 1. Most breast cancers are diagnosed when surgical resection is still an option, and yet many patients still develop recurrent disease. In an attempt to prevent recurrence, adjuvant systemic therapy and radiation therapy may be offered following surgical resection. Adjuvant systemic therapy refers to the administration, after primary surgery, of hormone therapy, chemotherapy, or trastuzumab (Herceptin: Genentech, San Francisco, CA, U.S.A.), a monoclonal antibody directed against her2/neu. Adjuvant treatment is intended to eliminate or delay the appearance of occult micro-metastatic disease, which is believed to be responsible for distant treatment failures after local therapy. The use of adjuvant treatment in combination with an effective screening strategy is believed to have contributed to a significant reduction in mortality from breast cancer in Western nations since the mid-1990s 2. Over the last few years, significant advances have been made in adjuvant therapy for breast cancer. The present topic review focuses on those advances and on recent trends in adjuvant therapy based on pivotal clinical trials—of hormonal therapy, of chemotherapy, and of therapy with biological agents—that have had a significant impact on treatment of early breast cancer. The practical impact of these therapies on the care of breast cancer patients is also discussed. A description of key upcoming trials in early breast cancer is also presented.