Best chemo treatment given I am ER -

I was recently diagnosed with Stage 1 Breast Cancer. I had a left breast mastectomy. Tumor characteristics as follows: 1.5 cm., invasive ductal carcinoma, lymph node negative (no metastatic tumor identified on both H&E and immunohistochemical pankeratin stains), grade-moderately differentiated w/ infiltrating ductal carcinoma w/ papillary features, estrogen receptor negative, progesterone receptor negative, HER2/neu (c-erb-B2) negative for overexpression .
What chemo drugs and regimen would you suggest to be the most effective? I am 44 years old? Thank you very much!

[CCF-RN,MSN-JS]

Dear lbb, On the basis of available data, it is accepted practice to offer cytotoxic chemotherapy to most women with primary breast cancers larger than 1cm in diameter (both node-negative and node-positive).  Randomized clinical trials have attempted to define optimal chemotherapy regimens, doses and schedules in the adjuvant treatment of breast cancer.  The National Health Institute (NIH) in December 2000, came out with a consensus statement regarding adjuvant therapy of breast cancer, and conclusions are based on an overview of the research to date and are as follows.

The administration of polychemotherapy (> or equal to 2 agents) is superior to single agents.  Four to six courses of treatment appear to provide optimal benefit.

Of course what would be of most benefit to you in your individual case would be decided based on careful review by, and discussion with, your oncologist.

Anthracyclines (such as doxorubicin and epirubicin) have been used as components of adjuvant polychemotherapy for breast cancer.  Available data indicate that adjuvant chemotherapy regimens that include an anthracycline result in a small but statistically significant improvement in survival compared to nonanthracycline-containing programs.  There is no evidence for excessive cardiac toxicity in women without significant preexisting heart disease with anthracyclines at the cumulative doses used in standard adjuvant protocols. Common combinations used are AC (adriamycin(doxorubicin) + cyclophosphamide) or CAF (cyclophosphamide + adriamycin + 5-flurouracil).  If concerns of cardiac toxicity, a common regimen is CMF (cyclophosphamide + methotrexate + 5-flurouracil)

Use of taxanes (docetaxel, paclitaxel) that have been demonstrated to be among the most active agents in the treatment of metastatic breast cancer.  As a result, the use of these drugs in the adjuvant setting has been explored.  To date there is no evidence to support the use of taxanes in node-negative breast cancer outside the setting of a clinical trial.

As your cancer was negative for both estrogen receptors and progesterone receptors hormonal adjuvant therapy would not be recommended.  Randomized clinical trials have not yet shown that such treatment substantially reduces the likelihood of recurrence or, in the case of tamoxifen, decreases the likelihood of breast cancer in the other breast.

[anne_marie]

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