Breast Neoplasms: Boér K

Boér K. · Szent Margit Kórház Onkológiai Osztály, Budapest. · Orv Hetil. · Pubmed #15715368 No free full text.

Abstract: INTRODUCTION: High frequency of cancer in older people and the improvements in life expectancy do not allow older age to be a barrier to treatment. The age is one of the risk factors for breast cancer development, one third of all cases occur in women older than 70 years. AIM: To provide an overview of the available information on the main issues in the field of surgery, radiotherapy and medical approaches to the treatment of breast cancer in the elderly. METHOD: The author discusses the treatment of breast cancer in the elderly, based on the data of literature. RESULTS: The assessment of any patient is the first step in the treatment process, performance status is more important than age. In older women a correct evaluation includes not only the basic medical history and the cancer staging, but also a detailed assessment of health and environment that may interfere with the therapeutic approach of the patient. Age is not a limitation for surgery, without any comorbidity it is safe, and operative mortality is low. The body self-image is important for most old women, they also wish to keep their breasts, so a conservative surgery and adjuvant radiotherapy should be offered to all, as long as the stage permits it. The selection of patients who are candidates for axillary dissection is based on selective lymph sentinel node technique which provides an optimal nodal staging with a minimal morbidity. The results of radiotherapy are as good as in younger patients, elderly women tolerate radiotherapy well. The inability to travel to the radiation facility is often the reason for omitting the radiation treatment and to choose a modified mastectomy. A promising alternative to the standard radiation treatment is the concept of intraoperative radiotherapy. Breast cancer in the elderly women is more likely to be well differentiated tumour, containing oestrogen and progesterone receptors. Based on these favourable prognostic factors, endocrine therapy is the standard treatment in adjuvant and metastatic setting for older women. When all hormonal options have been exhausted, elderly women should be treated with chemotherapy. Older patients often use several drugs concomitantly, and this polypharmacy may lead to possible clinically significant changes in the cytotoxic agent pharmacology. Supportive care can improve compliance of patients to chemotherapy. The introduction of oral and weekly applied cytotoxic treatments will allow a broader spectrum of patients to benefit from chemotherapy, particularly those with a poorer performance status. CONCLUSIONS: The use of a multidimensional geriatric evaluation permits a better selection of the best and individualized therapeutic decision for each patient. The growing number of treatment options in the elderly breast cancer patients will lead to an increase in survival and contribute to an improvement in their quality of life.

Boér K. · Szent Margit Kórház, Onkológiai Osztály, Budapest. · Orv Hetil. · Pubmed #14978885 No free full text.

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Boér K. · Onkológiai Osztály, Szent Margit Kórház, Budapest. · Orv Hetil. · Pubmed #11975393 No free full text.

Abstract: INTRODUCTION: Breast cancer is a systemic disease, unfortunately clinically undetectable micrometastases are present in many women even in early stages of the disease. Many of these patients can be cured with combined modality treatment of surgery, radiation and chemo- or hormone therapy. AIM: To survey the treatment of breast cancer. METHOD: The author presents an overview of the treatment of breast cancer based on the relevant literature and experience. RESULTS: Systemic adjuvant treatments include cytotoxic and hormone therapy. The most commonly used cytotoxic agents are cyclophosphamide, methotrexate, 5-fluorouracil, doxorubicin and epirubicin. The anthracycline-containing regimens are slightly superior, and the addition of taxane to an anthracycline-containing regimen may further increase the efficacy of adjuvant chemotherapy. Patients with metastatic disease cannot be cured, the goal of the treatment is to improve quality of life, and prolong survival. Up to 60-80% of these patients may experience objective tumor response to first-line combination chemotherapy. The taxanes (paclitaxel or docetaxel) with anthracyclines are the most active chemotherapy drugs against breast cancer. The best results are achieved with second-, third-line chemotherapy drugs: capecitabine, vinorelbine, gemcitabine, 5-fluorouracil and a variety of its oral pro-drugs. The most recent developments are represented by the biologically-targeted drugs, the first agent developed trastuzumab, has already been introduced in the clinic. The combination of chemotherapy with various response modifiers is a rapidly developing field of clinical cancer research. Several other new agents including growth factor receptor antagonists, tumor vaccines, antiangiogenic agents are tested in clinical trials alone and in combination with chemotherapy. CONCLUSIONS: The combination of chemotherapy with the new generation of drugs is a rapidly advancing and important field of clinical oncology.

Boér K, Láng I, Juhos E, Pintér T, Szántó J. · Onkológiai Osztály, Szent Margit Kórház, Budapest, 1032 Hungary. · Magy Onkol. · Pubmed #12975660 links to  free full text

Abstract: AIM: The authors present the Hungarian interim analysis and experience with the BCIRG 001 randomized, multicentric, phase III clinical trial comparing TAC (docetaxel, doxorubicin, cyclophosphamide) and FAC (5-fluorouracil, doxorubicin, cyclophosphamide) in the adjuvant treatment of node positive breast cancer patients. The results are presented according to international data. PATIENTS AND METHODS: Three Hungarian centers - St. Margit Hospital, Budapest, National Institute of Oncology, Budapest, Petz Aladár Hospital, Gyôr - participated in the international trial. Between June 1997 and June 1999, 61 patients with node positive breast cancer were enrolled in the study after the surgery. Thirty-four patients were randomized to TAC (75/50/500 mg/m2 6x q3wk) and 27 patients were randomized to FAC (500/50/500 mg/m2 6x q3wk) chemotherapy, with prospective stratification by node (1-3, 4+). In the case of patients with ER and/or PR positive tumours 5 years tamoxifen treatment was started. Radiotherapy was performed after the 6th cycle of chemotherapy. RESULTS: 36 months of follow up was performed. In both arms the hematological toxicity was more frequent. The TAC group showed a higher incidence of neutropenia (76%) compared to the FAC (22%), as well as a higher incidence of febrile neutropenia (26%), without grade 3-4 infection and there were no cases of septic death. Regarding non-hematological toxicity more grade 3-4 nausea and vomiting was observed in the FAC group. At three years follow up, the international results show statistically significant improvement in disease-free survival (82% vs. 74%, p=0.0011) in favour of TAC, and similar tendency was observed in the case of overall survival (92% vs. 87%, p=0.11). This benefit with TAC was seen regardless of hormone receptor status. Due to the low number of Hungarian patients we cannot declare the same results. CONCLUSIONS: Based on the international analysis TAC was superior to FAC chemotherapy. Additional follow up data will evaluate the role of TAC in the adjuvant setting of early breast cancer treatment. The results indicate that TAC has the potential to be incorporated in the new strategies of adjuvant breast cancer treatments.

Boér K, Láng I, Juhos E, Pintér T, Szántó J. · V. Department of Internal Medicine - Oncology, Szent Margit Hospital, Budapest, H-1032, Hungary. · Pathol Oncol Res. · Pubmed #14530809 links to  free full text

Abstract: The adjuvant chemotherapy of breast cancer changed in the past two decades. Docetaxel containing regimens are highly active in metastatic breast cancer. A logical approach was their incorporation into trials of early breast cancer adjuvant therapy. The authors present the Hungarian interim analysis and experience with the BCIRG 001 randomized, multicentric, phase III clinical trial comparing TAC (docetaxel, doxorubicin, cyclophosphamide) and FAC (5-fluorouracil, doxorubicin, cyclophosphamide) in the adjuvant treatment of node positive breast cancer patients. The results are presented compared to the international data. Three Hungarian centers - Szt. Margit Hospital, Budapest, National Institute of Oncology, Budapest, Petz Aladár Hospital, Gyôr - participated in the international trial. Between June 1997 and June 1999, 61 patients with node positive breast cancer were enrolled in the study after the surgery. Thirty-four patients were randomized to TAC (75/50/500 mg/m2 6xq3wk) and 27 patients were randomized to FAC (500/50/500 mg/m2 6x q3wk) chemotherapy, with prospective stratification by node (1-3, 4+). Patients with hormone receptor positive tumors received tamoxifen for 5 years after the chemotherapy. Radiotherapy was performed after the 6th cycle of chemotherapy. 33 months of follow up was performed. In both arms the hematological toxicity was more frequent. The TAC group showed a higher incidence of neutropenia (76%) compared to the FAC (22%), as well as a higher incidence of febrile neutropenia (26 % versus none), without grade 3-4 infection and there was no cases of septic death. More grade 3-4 nausea and vomiting was observed in the FAC group. At three years follow up, results indicated improvement in disease-free survival (88% vs. 76%) in favour of TAC, and similar tendency was observed in the case of overall survival (97% vs. 88%). Based on the international data analysis TAC was superior to FAC chemotherapy, the results show statistically significant differences between the two arms. This benefit with TAC was seen regardless of hormone receptor status. Additional follow up data will evaluate the role of TAC in the adjuvant setting of early breast cancer treatment.