Faculty Bibliography

The most useful new hormonal therapy against estrogen receptor-containing metastatic breast cancer is the development of antiestrogenic agents such as nafoxidine and tamoxifen. Both of these drugs possess antitumor activity comparable to that of other additive hormonal agents, and they are better tolerated for lack of any serious toxicity. The clinical usefulness of antiprolactin drugs in breast cancer is at present limited. Adrenal suppression using aminoglutethimide has been shown to induce useful remissions. We discuss the implications of new treatment modalities for the future management of disseminated breast cancer.

New concepts and treatments currently available for adjuvant studies are illustrated by a review of ongoing studies sponsored by the National Cancer Institute. More thorough information is needed on immunotherapeutic agents to allow more rationale in the use of these agents. Solid bases to properly select drugs or drug combinations for adjuvant purposes are being established. However, dose-schedule and duration of treatment are still to be defined. Strategies directed at prolonging the benefit of surgical adjuvant chemotherapy remain to be planned. Progress continuously achieved with immunotherapy and chemotherapy should rapidly broaden the spectrum of tumour types to be included in adjuvant studies.

A variety of adjuvant trials performed in the United States for osteogenic sarcoma, breast, lung, and colon cancer have achieved encouraging results and are briefly summarized. Trials in osteogenic sarcoma are reporting 2-year disease-free survival rates of 50%. However, they have only been evaluated against historical controls and there is some evidence that other factors might have greatly improved the disease-free survival in the absence of adjuvant therapy. The NSABP breast cancer trial only shows significant improvement for women under 50 years of age with 1 to 3 positive axillary nodes. A very promising trial using intrapleural BCG immunotherapy for squamous cell lung cancer is described. Also, two trials of 5-fluorouracil for colo-rectal cancer, both showing trends suggesting slight improvement among treated patients, are presented. Proper care in the design of adjuvant trials with sufficient attention paid to prognostic variables is urged.