Cancer Treatment Today » Adjuvant Treatment

Treating with chemotherapy before surgery for breast cancer

M Levin, MD — Fri, 28 Sep 2012 18:21:10 +0000

Neoadjuvant chemotherapy came into vogue in the seventies and eighties, spurred on by the success of organ preservation strategies in cancers such as laryngeal and rectal cancer. It used to be thought there are two potential benefits of neoadjuvant chemotherapy: downstaging a breast tumor so lesser surgery can be performed – lumpectomy instead of mastectomy, and to potentially treat early occult metastatic disease and to improve survival. The first goal can be successfully accomplished as has has been corroborated by large randomized studies but the second goal has not been proven to be accomplished by neaodjuvant chemotherapy. In fact, studies do not show a that women live longer after neaodjuvant chemotherapy. However, more recently, with improving chemotherapy effectiveness, it became appreciated that response is a predictive tool that can be used to plan farther chemotherapy. The idea is the giving chemo first can identify patients who need a more aggressive approach. However, NCCN still only recommends neoadjuvant therapy for women in stage IIA or higher and who desire breast preservation.

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Generic Versus Brand Name Aromasin

M Levin, MD — Sun, 05 Aug 2012 14:58:56 +0000

Brand-name Aromasin is manufactured by Pfizer, Inc. However, the patent for this medicine has expired in early 2012, and it is now available in generic form. Aromasin is available in generic form in one strength: exemestane 25 mg tablets.

Generic Aromasin is made by Roxane Laboratories, Inc., and Greenstone LLC. The version made by Greenstone is an “authorized generic,” which means that it is actually made by Pfizer and is actually the real, brand-name tablet but is packaged and sold as a generic.

There is no literature to support that brand is better then generic. All generic medications must undergo testing for bio-equivalence before the U.S. Food and Drug Administration (FDA) decides if the generics are equivalent to the brand-name medications and assigns a rating to each one.

An “AB” rating means that the FDA has determined that a generic medication is equivalent to a brand-name medication. The generic exemestane currently available has an “AB” rating, meaning it has been determined to be equivalent to Aromasin.

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Gemcitabine for Adjuvant Therapy of Breast Cancer

M Levin, MD — Tue, 19 Jun 2012 20:02:12 +0000

Occasionally one encounters the situation of a breast cancer patient who received four cycles on Adriamycin and Cytoxan as adjuvant therapy after her surgery, but when the second part of the treatment begins, and she received Taxol or Taxotere, she has a reaction and cannot tolerate it. Some physicians than give four cycles of gemcitabine instead of a taxane. Unfortunately, this practice has not been formally studied. Unlike for pancreatic cancer, there is not much literature regarding the use of gemcitabine for adjuvant therapy of breast cancer. One exception is the tANGo trial. The tAnGo trial was a randomized, open-label, multicenter phase III trial examining adjuvant treatment with epirubicin (Ellence)/cyclophosphamide (Cytoxan, Neosar) for four cycles followed by paclitaxel alone or combined with gemcitabine (Gemzar) for four cycles in patients with early-stage breast cancer. Gemcitabine has been included as a partner for paclitaxel in the tAnGo trial based on high response rates, including high complete response rates, observed in phase II trials of the combination in more advanced disease and based on the tolerability and safety of the combination compared with those of other taxane-containing two-drug combinations. It was not clear how much gemcitabine added to other drugs.

At this time gemcitabine is not well supported, alone or in combination for adjuvant therapy of breast cancer.

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