Fine-Tuning Breast Cancer Treatments: What Works Better?06/03/13
MONDAY, June 3 (HealthDay News) -- Two common schedules used for
the chemotherapy paclitaxel (Taxol) are equally effective at
controlling breast cancer, but fewer side effects are found with
the weekly regimen rather than every two weeks, according to a new
The estimated five-year progression-free survival rates were the
same for both groups, said Dr. G. Thomas Budd, who led the study.
While 82 percent of the group treated weekly had progression-free
survival five years later, 81 percent of the every two weeks group
However, "for the weekly group, overall the side effects seem
fewer, particularly the aches and pains," said Budd, a professor of
medicine at the Cleveland Clinic Lerner College of Medicine of Case
Western University, in Ohio.
He is due to present his findings Monday at the annual meeting
of the American Society of Clinical Oncology, in Chicago.
In another study, also to be presented Monday, Dr. Emiel
Rutgers, a surgical oncologist at the Netherlands Cancer Institute,
in Amsterdam, looked at the side effect of lymphedema -- a painful
swelling of the arm, breast and chest that can occur after breast
Lymphedema was about half as frequent in women with positive
axillary (armpit) lymph nodes who received radiation therapy in the
area than in women who had surgical removal of the nodes.
Both studies focus on the "fine-tuning" of breast cancer
treatments to maintain the benefits and reduce treatment side
According to Budd, doctors now typically are divided on the
regimen of Taxol, with some giving it weekly and others every two
weeks. "And we haven't known the best way to do it," he said.
In the study, he compared the two treatment schedules in more
than 2,700 breast cancer patients between 2003 and 2010. One group
got a standard dose of Taxol every two weeks for 12 weeks; the
other got low-dose Taxol weekly.
After finding no differences in survival rates, he looked at
side effects. Women on the two-week schedule had more allergic
reactions (1.4 percent of patients compared with 0.6 percent), more
muscle and bone pain (11 percent compared with 3 percent) and more
numbness and tingling in the extremities (17 percent versus 10
In practice, he said, most doctors who give the two-week regimen
give four cycles (rather than six cycles). He gave the same number
of cycles to each group to make the comparison more equal. So, the
"real-life" differences in some side effects, he said, may be
Many doctors are already using the weekly chemotherapy schedule,
according to Dr. Joanne Mortimer, director of women's cancer
programs and co-director of the breast cancer program at the City
of Hope Cancer Center, in Duarte, Calif. She reviewed the new
findings. "It could be practice-changing," she said, for doctors
not giving it weekly.
In the lymphedema study, Rutgers compared 744 breast cancer
patients with positive lymph nodes who had surgery to remove them
to 681 patients who received radiation to the area.
When the sentinel node -- the first draining node of a breast
tumor -- is found to have cancer cells, treatment is needed. The
standard is to remove all the nodes in the armpit area, but
radiation is an alternative.
A potential side effect of treatment, however, is
Rutgers followed the patients for five years. "After five years,
patients who had positive nodes and were treated with radiation had
half the lymphedema-associated problems as those treated with
surgery," he said.
In addition, at five years, 14 percent of the radiation group
developed lymphedema, but 28 percent of the surgery group reported
it, the investigators found.
However, Rutgers found no substantial differences between the
groups when he looked at overall survival or cancer-free
For her part, Mortimer noted that the radiation treatment
studied by Rutgers is more commonly done in Europe. But the option
is definitely being considered more in the United States, as well,
Women told they need treatment for affected lymph nodes, she
said, "should ask their doctor if radiation is a feasible
Because both studies were presented at a medical meeting, the
data and conclusions should be viewed as preliminary until
published in a peer-reviewed journal.
To learn more about lymphedema, visit the
American Cancer Society.
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