CHEMOTHERAPEUTIC PRINCIPLES THAT HAVE EMERGED for Breast Cancer

CHEMOTHERAPEUTIC PRINCIPLES THAT HAVE EMERGED for Breast Cancer

• Future trials should be designed to emphasize tumor eradication
and should not focus on questions that have already been answered.

• Multimodal regional therapy should be used as aggressively as possible.
Decreasing the tumor burden in patients with metastatic cancer
should improve chances of achieving a complete remission with
TAC induction adjuvant programs.

• If a new drug program shows superior efficacy, don’t let attachment
to a previous favorite be an obstacle to adopting it. Recall the long
delay before Adriamycin was incorporated into breast adjuvant therapy
and the continued use of inappropriate or suboptimal combinations
and schedules of Adriamycin (e.g., FAC-lite).

• The absence of measurable metastatic cancer creates a dilemma.
Probably the best solution is to frequently monitor the patient and
her tumor markers.

• Toxicity, especially irreversible damage, should be avoided if possible.
The persistence of Adriamycin cardiac toxicity represents a
major oversight on the part of medical oncology. Adriamycin
should be given only by continuous infusion over 48 96 h. This
necessitates placement of a permanent central venous catheter.

• Not all resistance that develops in some cancer clones is permanent,
as evidenced the return of Adriamycin sensitivity in some cancers
that initially became resistant to this drug.