The Pros and Cons of Breast C... Video Transcript

Participants

Renee Kemp , Hope S. Rugo MD, Carol L. Kornmehl MD, FACRO

Summary

For most breast cancer patients, adjuvant therapy is a crucial part of treatment. Like many successful drug therapies, however, adjuvant therapy can cause a number of side effects. Join Dr. Hope Rugo as she discusses these side effects and how doctors keep them from outweighing the benefits of therapy.

Webcast Transcript

RENEE KEMP: Welcome to our webcast. I'm Renee Kemp. Today we'll be answering more questions about adjuvant therapy and specifically how the benefits of therapy outweigh the negative side effects. Joining me today is Dr. Hope Rugo. She is the Associate Clinical Professor of Medicine at the UCSF Comprehensive Cancer Center. Thank you for joining us, Dr. Rugo.

Let's start by discussing the benefits of adjuvant therapy.

HOPE RUGO, MD: Adjuvant therapy is given to women who have breast cancer where we think they have a higher risk of recurrence someday. The recurrence risk from breast cancer might be in other parts of the body, but it's still breast cancer cells that move throughout the body. So when we're trying to look at adjuvant therapy, we're giving treatment after surgery. So after surgery that removes all evidence of the cancer to try and reduce the risk that cells that escaped and are sitting somewhere else in the body might grow back sometime later. So adjuvant therapy consists of chemotherapy, hormonal treatments and radiation treatments to prevent recurrence in the breast itself.

When we're making decisions for women, we're always weighing the risks vs. the benefits. So you want to do a risk vs. benefit analysis, much as we do in all other aspects of our lives, and come up with where you're weighted when you make that decision.

RENEE KEMP: So what is the role of an anthracycline. Does it increase the benefits?

HOPE RUGO, MD: A big overview analysis has been done and is updated every two years. And this has looked at many, many women who have been treated on trials, clinical trials in Europe and in the United States. In those trials, they're able to gather data to try and make better sense of what treatments are better than other treatments. And from this big overview analysis as it's called, recent data has shown that anthracyclines given for women whose cancer has spread to nodes under their arm, axillary nodes, the anthracyclines improve survival and reduce the risk of recurrence compared to the non-anthracycline chemotherapy treatments.

RENEE KEMP: If you would, Dr. Rugo, discuss some of the side effects of adjuvant therapy.

HOPE RUGO, MD: You know the side effects depend, of course, very much on the treatment regimen. But chemotherapy that we use for breast cancer generally causes hair loss, some nausea and vomiting, some drop in the blood counts that's temporary. Sometimes there is a little discomfort in the mouth or change in taste and some fatigue. Those side effects are all temporary and most we've found can be significantly improved by just giving medications, paying very close attention, making sure that we react to problems that are occurring and give medications to prevent those problems.

For anthracyclines one concern has been damage to the muscle of the heart that causes weakness of the heart. But we know now that if we limit the amount of chemotherapy and carefully choose the treatments that we're giving to the patients and evaluate their heart when appropriate beforehand, that we can really limit the risk of heart damage to very, very small amounts.

RENEE KEMP: Do the benefits of using an anthracycline outweigh the negatives?

HOPE RUGO, MD: I think they do for node positive breast cancer. In other words, breast cancer that's spread to a node under the arm and for some breast cancers where there isn't evidence of cancer under the arm, anthracyclines are better in terms of reducing risk of recurrence and improving survival. Because we can usually give that treatment in a fairly short period of time, side effects are short-lived.