Interview
with Neil Love, MD from Breast Cancer Update for Medical Oncologists,
Program 2 2000
Play
Audio Below:
My
approach to the patient is that the first question you ask is whether
this patient should get endocrine therapy or not. And if you decide
they’re going to get endocrine therapy and, by and large, that
still for me means tamoxifen for both groups, and the LHRH agonist
we’ve talked a little bit about. Then the second question is,
"What does chemotherapy add?" On the other hand, if there’s
a patient who is receptor-negative then, more often than not I’m
going to treat with chemotherapy, although it depends entirely upon
what their risk is. So that, let’s say, you’ve got an
eight millimeter tumor that happens to be – let’s say
– medium grade that happens to be ER-negative and you’re
sure that it’s ER-negative, but all the other factors are fairly
good. You might not want to treat with hormone therapy, but the
benefits of chemotherapy – the absolute benefits may be small
because the risk is small. That woman you have to give the option
of no therapy too. But if the risk is higher than that – 30%,
and for many patients if it’s 15 to 30%, then I believe you’re
obligated to tell her that the single most effective regimen is
four cycles of CA followed by four cycles of Taxol. Now she may
choose to have one of the other regimens. She may be prepared to
say, "Well, look, these other regimens have benefit –
they may not have as much benefit, but they have a benefit and I’m
not willing to be treated for six months" or "I’m
not willing to have adriamycin because of the hair loss." Therefore,
they may choose CMF or "I’m not prepared for the long
term risk of cardiac damage from Adriamycin." So there are
reasons why a patient might choose CA or CMF; but I think our job
as doctors still has to be to make certain that they understand
that this is a trade-off. One would say not one that I want to make,
but it’s still a trade-off.
