Editor’s Note
	Research To Practice

In our 1988 inaugural issue of Breast Cancer Update, Dr Bernard Fisher was the first research leader interviewed. At that time, a National Cancer Institute “ Clinical Alert” had just been mailed to every oncologist in the United States. The “Clinical Alert” released data from several major randomized clinical trials that evaluated adjuvant systemic therapy in breast cancer patients with nodenegative disease. The NCI — then under the direction of another one of our interviewees, Vincent DeVita — reasoned that these groundbreaking clinical trial data were critical to the management of a large number of women and that the usual peer-review process should be circumvented to provide clinicians immediate access to these results.

Two of the studies that were part of the NCI’s Clinical Alert were NSABP trials, and Dr Fisher seemed the logical person to query about the daily practice implications of these groundbreaking results. Armed with a list of case scenarios to present for feedback, my enthusiasm was immediately crushed when Dr Fisher replied, “Patients should be entered into clinical trials. It’s not the role of the clinical researcher to interpret data or tell people how to practice.”

In the first few years of this audio series, Dr Fisher’s opinion was shared by a number of investigators interviewed. Gradually, the pendulum shifted and I began to identify researchers who were willing to discuss their own management strategies for patients in a nonprotocol setting. Today, almost all of our interviews include these highly valued insights and experiences.

The Breast Cancer Update team has also been very interested in how community-based oncologists manage their patients. In 1995, we began using electronic keypad polling at meetings and national telephone surveys to assess oncologists’ practice patterns. Our current approach to continuing medical education involves the integration of data about the practice patterns of research leaders and community-based oncologists into all of our programs.

In that regard, the enclosed supplement to this issue includes dozens of keypadpolling questions posed at the recent Miami Breast Cancer Conference. We have supplemented these data with research results and ongoing clinical trial designs, in order to create a snapshot of how recent research findings are being integrated into clinical practice.

For this issue, Dr Fisher again joins us to share his views on where we are at the moment in clinical research and where we might likely be headed in the next decade. No one has done more to help breast cancer patients than Dr Fisher, and it is always an honor to speak with this legendary leader. As usual, he ”didn’t know what he had to say that people would want to hear about,” but, of course, he provides a fascinating commentary on chemoprevention, preoperative chemotherapy, breast-conserving surgery and other major paradigm shifts that he engineered. True to form, he still avoids interpreting research data from a patient-care perspective.

Elsewhere in this issue several of our guests are more willing to talk about their current practice strategies. Mike Dixon discusses his use of aromatase inhibitors in the neoadjuvant and adjuvant setting, Edith Perez provides insight about her use of trastuzumab in metastatic disease, and Michael Gnant is very candid in his review of therapy for premenopausal women with estrogen receptorpositive cancers.

During a recent “Meet the Professor” session in Dallas, community-based medical oncologist, Barry Brooks — while presenting a particularly difficult case from his practice — made the following comment, which framed a pivotal message from our audio series:

“ Medical oncologists are a modern day manifestation of the myth of Prometheus — chained to the rock, and every day, the big predatory bird comes and eats away part of him, and then overnight he regrows, the next day to be partially consumed again. Your Breast Cancer Update series is very helpful because you are able to discern that no one knows how to take care of some of these patients. And it gives oncologists comfort that we’re all in the same large boat, even though it may be somewhat painful from time to time.”

Every day, oncologists likes Drs Dixon, Perez and Gnant, who devote their careers to breast cancer research, education and patient care, encounter clinical situations that have no perfect solutions. We are fortunate that these research leaders and many others are willing to share their perspectives and experiences on these challenging situations.

— Neil Love, MD

National Cancer Institute: Clinical alert from the National Cancer Institute. Breast Cancer Res Treat 1988;12:3-5. No Abstract Available.

NIH Consensus Conference: Treatment of early-stage breast cancer. JAMA 1991;265:391-95. No Abstract Available.

DeVita VT Jr, Hubbard SM. NCI's breast cancer clinical alert: Rationale and results. Resid Staff Physician 1989;35(8):49-55. Abstract

Fisher B et al. A randomized clinical trial evaluating sequential methotrexate and fluorouracil in the treatment of patients with node-negative breast cancer who have estrogen receptor-negative tumors. N Engl J Med 1989;320:473–8. Abstract

Fisher B et al. A randomized clinical trial evaluating tamoxifen in the treatment of patients with node-negative breast cancer who have estrogen receptor-positive tumors. N Engl J Med 1989;320:479–84. Abstract

Johnson TP et al. Effect of a National Cancer Institute Clinical Alert on breast cancer practice patterns. J Clin Oncol 1994;12(9):1783-8. Abstract

Mansour EG et al. Efficacy of adjuvant chemotherapy in high-risk node-negative breast cancer. An intergroup study. N Engl J Med 1989;320:485–90. Abstract

Mariotto A et al. Trends in use of adjuvant multi-agent chemotherapy and tamoxifen for breast cancer in the United States: 1975-1999. J Natl Cancer Inst 2002;94:1626-34. Abstract

Spratt JS, Greenberg RA. Validity of the clinical alert on breast cancer. Am J Surg 1990;159(2):195-8. Abstract

Home · Search