The state of the art of adjuvant therapy in breast cancer

Abstract

Adjuvant systemic therapy has been shown to reduce relapses in treated women and to prolong their survival. This is true for all studied subpopulations. Multidrug chemotherapy for the duration of 6 months with the addition of tamoxifen for patients with hormone receptorpositive tumors and for the premenopausal patients, and tamoxifen or short-term chemotherapy with long-term tamoxifen for the postmenopausal patients represent the treatments of choice to reduce the risk of relapse. In general, patients should be treated with a much more individualized adjuvant therapy program than is currently being prescribed. Current practice is based largely on estimates of average chemotherapy effects obtained from patients with heterogeneous disease and menopausal status characteristics. Some of the open questions relate to i) the definition of the populations for which risk of relapse justifies therapy, and ii) the optimal way of using available therapies might find answer from ongoing research in the next future. The modest but real improvement of the prognosis in operable breast cancer was exclusively obtained by means of clinical trials, and it is mandatory that participation in programs of clinical research become medically and socially the treatment of choice for patients and for their doctors.