The CancerWeb Report, What's New In Cancer: September, 1996
Breast Cancer

• Intravenous pamidronate for bone metastases in breast cancer patients - Bone metastases are a major cause of pain, fractures, reduced mobility, and high blood calcium levels in patients with advanced breast cancer. Growth of the metastases disrupts bone structure and metabolism, and causes loss of bone. Pamidronate, a phosphorus-containing drug, inhibits this bone destruction and its symptoms, according to a report by the Aredia Multinational Cooperative Group. In an article appearing in the September, 1996 issue of the Journal of Clinical Oncology, these clinical scientists described marked pain relief and a 48% increase in the time period before disease progressed further in those taking pamidronate infusions. (Conte, J Clin Oncol 14:1552, 1996)

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• Stimulation of bone marrow recovery by filgrastim permits a major increase in dose of the chemotherapy drug mitoxantrone - The use of natural growth factors such as filgrastim (G-CSF) to stimulate recovery of bone marrow from the effects of chemotherapy is becoming a widespread practice. It also permits the use of drugs at higher doses than are possible without the stimulation. However, it is necessary to determine just how much the dose can be increased safely. Clinicians from the US Eastern Cooperative Oncology Group reported in the September, 1996 issue of the Journal of Clinical Oncology that the dose of a promising newer drug, mitoxantrone (related to doxorubicin or Adriamycin), used in combination with cyclophosphamide, can be increased 2- to 2.8-fold when filgrastim is administered. In this trial, objective responses to treatment were seen in 45% of treated breast-cancer patients. (Sparano, J Clin Oncol 14:2576, 1996)

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• Docetaxel at a lower dose for advanced breast cancer - A report from the Clinical Screening Group of the European Organization for Research and Treatment of Cancer (EORTC) appeared in the August, 1996 issue of the British Journal of Cancer. In this study, docetaxel at 75 rather than the usual dose of 100 mg/m2 produced a response rate of 52% in women with advanced disease. While lower than the 68% reported for the higher dose, this response rate was still comparable with the 43% achieved with another active drug doxorubicin, and the patients did not require hospitalization and did not experience the severe grade 4 toxicity of the higher dose. (Dieras, Brit J Cancer 74:650, 1996)

  Editor's Comment: - The usual aim of chemotherapy is to achieve the highest tolerated dose based on prior therapeutic trials, in the hope of maximizing the effect on the tumor. It should be recognized, however, that this is not always feasible, and not always even a desirable objective. The level of side-effects associated with standard maximum tolerated doses may not be a fair trade-off for the slight improvement in anticancer effect achieved. Also in advanced disease in debilitated patients, the maximum tolerated dose may in fact be much lower than for patients in better condition, and their susceptibility to complications much greater. Finally, factors such as ability to deliver drug safely in an outpatient setting, as in this study, are very important.