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Chemotherapy combination proves effectiveBupa investigative news - 5 June 2003
Each year 40,000 new cases of breast cancer are diagnosed in the UK. Many people receive chemotherapy treatment as a result, but according to researchers, hundreds more lives could be saved following the discovery of a powerful cocktail of drugs. So what is the combination, how was it discovered and what does this mean for patients? What were the headlines?Details of the research appeared in a range of UK newspapers and online news sites. Amongst the headlines were reports entitled, "Drugs cocktail hope for cancer", "Extra chemotherapy cuts deaths", "New cocktail of drugs cuts deaths from breast cancer", "Scientists stunned as pioneering British research cuts death rate by 30 per cent", and "Drug regime boosts breast cancer survival". As breast cancer is a key concern, most publications gave reasonable space to report the findings and the general perspective was positive. What is the bigger picture?The trial, called NEAT (National Epirubicin Adjuvant Trial), was conducted by Cancer Research UK and details were announced at the American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago. The trial involved 65 hospitals in the UK and 2027 patients with early stage breast cancer. The patients were randomly assigned to two groups and either given treatment with four rounds of epirubicin and four of CMF (which consists of the drugs Cyclophosphamide, Methotrexadte and 5 FU) or given six rounds of CMF alone. The CMF group had daily tablets and weekly injections for two weeks, followed by two weeks rest. The four-week cycle has then repeated six times - a total of 24 weeks treatment. The epirubicin group (ECMF) had an injection of the epirubicin once a week for three weeks, followed by four cycles of CMF - a total of 19 weeks treatment. All patients were followed up regularly and details of any side effects were obtained. The eventual results showed that women treated with epirubicin were 31 per cent less likely to relapse or die than those treated with CMF alone. Researcher Dr Chris Poole, from the Cancer Research UK Clinical Trials Unit at the University of Birmingham, said, "Modern chemotherapy treatments usually involve a cocktail of drugs that work together to prevent cancer recurrence. Through clinical trials these combinations have been refined over the years and survival rates have gradually improved. This particular trial has yielded a dramatic difference in survival, and it's incredibly rare to get such a significant increase by using existing drugs in a slightly different way." According to Cancer Research UK, epirubicin has been approved by the National Institute for Clinical Excellence (NICE) and last year they recommended that chemotherapy for breast cancer should include the drug or something similar. However, until now it's been unclear how best to integrate the drug into existing treatment regimes. Another researcher, Dr Helena Earl from the University of Cambridge, said, "Chemotherapy is an important part of treatment for many women affected by breast cancer but there has been considerable debate and uncertainty as to the best drug regime. This trial provides clear evidence on which drugs to use, which order to give the drugs, and how much to give. We hope that in the future all patients will benefit from this information and gain access to the best possible chemotherapy treatments."
What does this mean?"These findings about the use of epirubicin for treatment of women with early breast cancer appear to be very promising," said Dr. Michelle Barclay, from Breakthrough Breast Cancer. "Women tell us chemotherapy can be a very traumatic time. These results show that this regime could significantly improve the chances of surviving breast cancer and will be welcome news for many." She added, "More women than ever before are surviving breast cancer due to screening, awareness and the development of new therapies. This trial highlights the vital importance of research into new and improved treatments." Liz Cheesman, a helpline nurse at Breast Cancer Care, said, "Breast Cancer Care welcomes the results of the Cancer Research UK trial, announced at ASCO last week. The NEAT trial clearly shows that by adding the drug epirubicin to the chemotherapy treatment CMF, a marked benefit in survival and a reduction in the number of recurrences is evident." "Stemming from the results of this NEAT trial, we would urge that epirubicin is put forward to NICE (National Institute for Clinical Excellence) to be reviewed as part of their appraisal process of cancer drugs," she added. Kate Law, head of clinical trials at Cancer Research UK, commented, "This research highlights the need for large scale trials to discover exactly which treatment is the most beneficial to patients. These results show that, for some patients, getting the right chemotherapy can be the key to survival."
What does this mean to me?Although epirubicin significantly helped breast cancer patients, like other chemotherapy drugs, it isn't without side effects, leading Liz Cheesman to advise, "Women should take into account that epirubicin has a side effect of temporary hair loss." Combination therapy itself isn't new and there are various drugs are used in chemotherapy, in different ways and with different combinations, depending on the individual. Although epirubicin is already used in some cases, it's never been used in the combination or quantities studied in the trial. Coping with a breast cancer diagnosis and being faced with a multitude of treatment options can seem overwhelming. But according to Dr. Michelle Barclay, "All women with breast cancer need full information about their treatment options and associated side effects in order to make informed decisions about treatment choices." Catching breast cancer early is crucial, as it allows treatments such as chemotherapy to be used as soon as possible. Being aware of the disease is vital, and experts continue to stress the importance of being breast aware and taking up screening invitations. As Professor Robert Souhmi, clinical director at Cancer Research UK, said, "Early detection remains very important in preventing deaths from breast cancer and it is essential that women are aware of this and attend for screening when they are invited." SummaryAs more advances are made and new combinations tried, chemotherapy treatments are gradually increasing survival rates and offering extra hope for patients. The results of the NEAT trial add a new dimension to the existing knowledge and it's hoped the treatment can be put into action with future patients. Links for more information
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