Thirty years ago, Bonadonna and his colleagues proved that adjuvant chemotherapy made a difference to survival following initial surgery in women with early breast cancer (Levine & Whelan NEJM 2006;355:1920-2). The original agents, cyclophosphamide, methotrexate and flurouracil (CMF) have been the gold standard against which newer drugs are assessed.
There have been numerous trials of chemotherapy mainly studying anthracyclines and taxanes in various combinations which are of interest to oncologists, but gynaecologists and GPs need to know that:
* adjunct postoperative chemotherapy has a modest benefit on survival
* it has considerable toxicity and is expensive
* its use is determined by the risk of recurrence which in turn depends on tumour size, axillary node status and pathology grade
* receptor status for human epidermal growth factor (HER2) and treatment with trastuzumab is a promising development
* oestrogen receptor status and hormonal treatment with tamoxifen greatly reduces recurrence.
Trials like that of Poole et al (pp 1851-62) will continue to refine the best combination of agents but the next major step forward will be the use of microarray techniques to identify each tumour's gene profile and then tailor the therapy individually.
