Adjuvant systemic therapy for breast cancers: overview

Any invasive breast cancer is associated with some risk of distant organ micrometastatic disease, and the risk of breast cancer mortality is reduced by delivery of systemic therapy as adjuvant treatment after primary surgery. The absolute benefit from adjuvant therapy will depend on the patient's underlying risk of relapse. Patients who have node-positive breast cancer therefore have the largest-magnitude benefit from adjuvant therapy. Conversely, patients who have small, node-negative cancers must balance the toxicity of systemic therapy against the estimated risk of metastatic disease, because some of these patients will have an excellent outcome with primary surgery alone. Web-based computerized programs such aswww.adjuvantonline.com provide patients and clinicians with a summary of calculated risks versus benefits from systemic therapy based upon primary clinicopathologic features. Genetic profiling and assignment of a recurrence score via the Oncotype DX test can be helpful in determining benefit from adjuvant chemotherapy in addition to endocrine therapy for ER-positive, node-negative cases.
ER-responsive breast cancer (ER- or PR-positive disease) will usually require tamoxifen or an aromatase inhibitor if the patient is postmenopausal. Chemotherapy is recommended for high-risk endocrine-responsive disease (eg, node-positive breast cancer), and for any endocrine-resistant breast cancer that is deemed appropriate for systemic treatment. Trastuzamab is indicated as targeted therapy to follow chemotherapy for HER-2/neu-overexpressing cancers. for further details ..... read ..Surgical Clinics of North America - Volume 87, Issue 2 (April 2007