KEY POINTS:
Doctors announced yesterday that a chemotherapy "super-cocktail" given to women with breast cancer reduced deaths by more than 30 per cent compared with the standard treatment.
The improvement was described as "dramatic" and over three times what was expected by researchers from the University of Birmingham, who did studies in England and Scotland.
It confirms results reported in 2003 and comes on top of recent survival gains from the use of the hormonal treatment Herceptin. Women treated with the new chemotherapy regimen followed by Herceptin have a near 50 per cent reduction in recurrence of the cancer.
But the specialist who led the studies said many women with breast cancer in Britain were not being treated with the right dose of chemotherapy in the right schedule to give the best chance of recovery and survival.
Chemotherapy is given to women with early breast cancer after surgery and radiotherapy to mop up any molecules of the cancer that may have spread round the body to other organs.
Its use has been established since 1976 after trials showed that the standard three-drug chemotherapy cocktail significantly improved survival rates by around 12 per cent.
But adding the fourth drug, Epirubicin, increased the survival rate to over 30 per cent in the studies of 2400 women at 75 hospitals across Britain.
The results of the studies are published in the latest New England Journal of Medicine.
Chris Poole, oncologist at the University of Birmingham, said: "The size of the treatment benefit is dramatic and surpassed all expectations. The results show conclusively that the addition of Epirubicin to chemotherapy has a significant impact on survival."
He said most women with breast cancer in Britain would be treated with Epirubicin. "But whether they are getting it in the right dose and on the right schedule is another matter."
High doses of the Epirubicin were administered for the first four cycles of treatment, then replaced with standard chemotherapy, maximising the impact of the drug but minimising the serious long-term risks such as leukaemia.
The women were recruited between 1996 and 2001 and the study looked at the recurrence of tumours and overall survival rates. Unlike Herceptin, which is only effective in 20 per cent of patients with oestrogen-positive breast cancer, chemotherapy works for all women.
"It is an old fashioned blunderbuss treatment. It is not targeted at specific groups and it does seem to be uniformly effective against all sub-types [of the disease]," said Dr Poole.
The evidence showed that the effects of hormonal drugs such as tamoxifen and Herceptin given after chemotherapy had a cumulative effect, on top of any survival gain achieved by the chemotherapy, he said.
Other developments on the horizon would lead to more improvements in the treatment of breast cancer. An editorial accompanying the study says "considerable progress" has been made in the fight against breast cancer but much remains to be done. Although chemotherapy improves survival and reduces recurrence "the magnitude of the benefit is modest and many patients have to be treated to benefit a few."
- INDEPENDENT
