WEDNESDAY, June 2 (HealthDay News) -- For patients with early
stage breast cancer, taking chemotherapy drugs sequentially over
six months helps improve their survival compared to taking them at
the same time over a shorter three-month span, a new study
The new findings will probably come as a relief to doctors, most
of whom already follow the sequential protocol, said Dr.
Bhuvaneswari Ramaswamy, a breast oncologist with the Ohio State
University Comprehensive Cancer Center--Arthur G. James Cancer
Hospital and Richard J. Solove Research Institute in Columbus.
But the "most exciting and surprising finding," said study lead
author Dr. Sandra M. Swain, was that younger women who went into
early menopause because of their chemotherapy -- in other words,
those who stopped having periods -- were more likely to live
"That's something that's not been reported," added Swain, who is medical director of the Washington Cancer Institute, Washington Hospital Center in Washington, D.C.
And this was true irrespective of whether the women's cancers
were estrogen-receptor positive (meaning estrogen furthers their
growth) or not.
In the study, reported in the June 3 issue of the
New England Journal of Medicine, the authors tracked outcomes for almost 5,400 women with early stage breast cancer that had spread to at least one lymph node.
The patients were randomly divided into one of three treatment
groups: the sequential group, which involved three drugs
(doxorubicin, cyclophosphamide and docetaxel) taken in sequence
over six months; or one of two "concurrent" groups, where women
received either two or three of these medications concurrently for
After eight years of follow-up, 83 percent of patients in the
sequential group were still alive compared to 79 percent of those
in the concurrent groups, the authors report.
Disease-free survival was also better in the sequential group,
leading to the conclusion that a longer course of treatment remains
better than a shorter course, the study said.
However, an accompanying editorial in the journal pointed out
that the side effects associated with the longer program might not
be worth the small survival advantage for many women.
As to the issue of amenorrhea (cessation of menstrual cycles)
also improving survival, Swain said, this "really generated a new
hypothesis that connects cessation of menses with survival."
No periods mean less estrogen is circulating in the body and
estrogen is known to fuel certain types of cancers. But that isn't
a likely explanation in this study, given that amenorrhea also
resulted in longer survival even in women whose tumors were
estrogen-receptor (ER) negative -- that is, their cancers don't
respond to estrogen.
"This [study] gives us a hint that women who stop having their periods -- even in the patients who are not ER positive -- may have a survival advantage," said Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La.
However, given that so much remains unknown, the message to
not that suppressing ovarian function is a way to reduce
their risk of breast cancer, said another study author, Dr. Charles
E. Geyer Jr., director of medical affairs of the National Surgical
Adjuvant Breast and Bowel Project (which conducted the trial) and
vice chair of human oncology at Allegheny General Hospital in
To learn more about breast cancer, visit the
U.S. National Cancer Institute.