17 research outputs found
Docetaxel vs 5-fluorouracil plus vinorelbine in metastatic breast cancer after anthracycline therapy failure
This multicentre, randomised phase III study compared docetaxel with 5-fluorouracil+vinorelbine in patients with metastatic breast cancer after failure of neo/adjuvant or one line of palliative anthracycline-based chemotherapy. One hundred and seventy-six metastatic breast cancer patients were randomised to receive docetaxel (100 mg m−2) every 3 weeks or 5-fluorouracil+vinorelbine: 5-fluorouracil (750 mg m−2 per day continuous infusion) D1–5 plus vinorelbine (25 mg m−2) D1 and D5 of each 3-week cycle. Eighty-six patients received 516 cycles of docetaxel; 90 patients received 476 cycles of 5-fluorouracil+vinorelbine. Median time to progression (6.5 vs 5.1 months) and overall survival (16.0 vs 15.0 months) did not differ significantly between the docetaxel and 5-fluorouracil+vinorelbine arms, respectively. Six (7%) complete responses and 31 (36%) partial responses occurred with docetaxel (overall response rate 43%, 95% confidence interval: 32–53%), while 4 (4.4%) complete responses and 31 (34.4%) partial responses occurred with 5-fluorouracil+vinorelbine (overall response rate 38.8%, 95% confidence interval: 29–49%). Main grade 3–4 toxicities were (docetaxel vs 5-fluorouracil+vinorelbine): neutropenia 82% vs 67%; stomatitis 5% vs 40%; febrile neutropenia 13% vs 22%; and infection 2% vs 7%. There was one possible treatment-related death in the docetaxel arm and five with 5-fluorouracil+vinorelbine. In anthracycline-pretreated metastatic breast cancer patients, docetaxel showed comparable efficacy to 5-fluorouracil+vinorelbine, but was less toxic
A case report of carcinoma of uterine cervix throwing heterochronous metastasis to the skin, spleen, and pancreas: the role of multimodality treatment approach
Effect of Expression of P-glycoprotein on Technetium-99m Methoxyisobutylisonitrile Single Photon Emission Computed Tomography of Brain Tumors.
SYSTEMIC TREATMENT OF EARLY BREAST-CANCER BY HORMONAL, CYTOTOXIC, OR IMMUNE THERAPY - 133 RANDOMIZED TRIALS INVOLVING 31000 RECURRENCES AND 24000 DEATHS AMONG 75000 WOMEN .2.
EFFECTS OF RADIOTHERAPY AND SURGERY IN EARLY BREAST-CANCER - AN OVERVIEW OF THE RANDOMIZED TRIALS
Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials
Background In early breast cancer, variations in local treatment that substantially affect the risk of locoregional
recurrence could also affect long-term breast cancer mortality. To examine this relationship, collaborative metaanalyses
were undertaken, based on individual patient data, of the relevant randomised trials that began by 1995.
Methods Information was available on 42 000 women in 78 randomised treatment comparisons (radiotherapy vs no
radiotherapy, 23 500; more vs less surgery, 9300; more surgery vs radiotherapy, 9300). 24 types of local treatment
comparison were identified. To help relate the effect on local (ie, locoregional) recurrence to that on breast cancer
mortality, these were grouped according to whether or not the 5-year local recurrence risk exceeded 10% (�10%,
17 000 women; �10%, 25 000 women).
Findings About three-quarters of the eventual local recurrence risk occurred during the first 5 years. In the
comparisons that involved little (�10%) difference in 5-year local recurrence risk there was little difference in
15-year breast cancer mortality. Among the 25 000 women in the comparisons that involved substantial (�10%)
differences, however, 5-year local recurrence risks were 7% active versus 26% control (absolute reduction 19%), and
15-year breast cancer mortality risks were 44·6% versus 49·5% (absolute reduction 5·0%, SE 0·8, 2p�0·00001).
These 25 000 women included 7300 with breast-conserving surgery (BCS) in trials of radiotherapy (generally just to
the conserved breast), with 5-year local recurrence risks (mainly in the conserved breast, as most had axillary
clearance and node-negative disease) 7% versus 26% (reduction 19%), and 15-year breast cancer mortality risks
30·5% versus 35·9% (reduction 5·4%, SE 1·7, 2p=0·0002; overall mortality reduction 5·3%, SE 1·8, 2p=0·005).
They also included 8500 with mastectomy, axillary clearance, and node-positive disease in trials of radiotherapy
(generally to the chest wall and regional lymph nodes), with similar absolute gains from radiotherapy; 5-year local
recurrence risks (mainly at these sites) 6% versus 23% (reduction 17%), and 15-year breast cancer mortality risks
54·7% versus 60·1% (reduction 5·4%, SE 1·3, 2p=0·0002; overall mortality reduction 4·4%, SE 1·2, 2p=0·0009).
Radiotherapy produced similar proportional reductions in local recurrence in all women (irrespective of age or
tumour characteristics) and in all major trials of radiotherapy versus not (recent or older; with or without systemic
therapy), so large absolute reductions in local recurrence were seen only if the control risk was large.
To help assess the life-threatening side-effects of radiotherapy, the trials of radiotherapy versus not were combined
with those of radiotherapy versus more surgery. There was, at least with some of the older radiotherapy regimens, a
significant excess incidence of contralateral breast cancer (rate ratio 1·18, SE 0·06, 2p=0·002) and a significant
excess of non-breast-cancer mortality in irradiated women (rate ratio 1·12, SE 0·04, 2p=0·001). Both were slight
during the first 5years, but continued after year 15. The excess mortality was mainly from heart disease (rate ratio
1·27, SE 0·07, 2p=0·0001) and lung cancer (rate ratio 1·78, SE 0·22, 2p=0·0004).
Interpretation In these trials, avoidance of a local recurrence in the conserved breast after BCS and avoidance of a
local recurrence elsewhere (eg, the chest wall or regional nodes) after mastectomy were of comparable relevance to
15-year breast cancer mortality. Differences in local treatment that substantially affect local recurrence rates would,
in the hypothetical absence of any other causes of death, avoid about one breast cancer death over the next 15years
for every four local recurrences avoided, and should reduce 15-year overall mortality