Mrs Y, 38, was recently diagnosed with left breast cancer and she underwent left mastectomy and axillary clearance 3 weeks ago.
HPE report: Infiltrating ductal cancer, grade 3, pT3N0M0 (stage 2), ER negative, HER2 negative, LVI positive, margin clear.
She was planned for adjuvant chemotherapy and radiotherapy to left chest wall.
Mrs Y wanted to know why she needs to undergo adjuvant chemotherapy?
Adjuvant treatment is the additional treatment given after primary surgical treatment to increase the chance of cure.
Yes, cancer can be cured if it’s detected before it spread/ metastasize (stage 4) and patients complete multi-modality cancer treatments.
Multi-modality cancer treatments include:
- surgery (mastectomy or breast conserving surgery AND axillary lymph node dissection or sentinel lymph node dissection)
- radiotherapy (breast, chest wall, SCF and/ or axilla)
- hormonal therapy (tamoxifen, letrozole, anastrozole, exemestane)
- targeted therapy (trastuzumab/ Herceptin)
Fisher hypothesis, “…that breast cancer was a systemic disease and that tumor cells were likely to have been disseminated throughout the body by the time of diagnosis…”
No matter how great a surgeon or how radical a surgery is, breast cancer will always recur if there is no systemic treatment/ adjuvant after surgery (unless in very early stage 1 breast cancer AND favorable histologic features eg. grade 1, ER positive, HER2 negative).
Thus, besides locoregional treatment with adjuvant radiotherapy, systemic treatments; adjuvant chemotherapy, hormonal (if ER positive) and targeted treatments (if HER2+/ over-expressed) will be needed to deal with breast cancer, which is a systemic disease.
For the patient above, her systemic treatment will only be adjuvant chemotherapy as she had negative for both estrogen receptor (ER) and HER2.
Unlike in advanced cancer where I like to see which sequence of chemotherapy or treatments will help to prolong progression free survival and overall survival, the aim adjuvant treatment here is for cure and for patients to live their natural life fully.
As the aim is for cure, there will be no more subsequent chemotherapy after the first line. So, the best chemotherapy regime should be used.
Which adjuvant chemotherapy regime offer the highest chance of cure?
Another way to understand the importance of adjuvant chemotherapy is to key in relevant information from her HPE report into Predict ver 2.0 and you can see the graph below to see the difference in overall survival (2nd vs. 3rd generation chemotherapy).
I. With 2nd generation chemotherapy:
II. With 3rd generation chemotherapy:
As you can see above, addition of adjuvant chemotherapy improve both 5- and 10-year survival and further improvement can be obtained by using third generation adjuvant chemotherapy.
Third generation chemotherapy, when compared with second generation chemotherapy:
- Increase the number of survival at 5-years from 79 to 82 out of 100 women, additional 3 women survive in 5 years period.
- Increase the number of survival at 10-years from 71 to 75 out of 100 women, additional 4 women survive in 10 years time.
One more thing, I had just explained one very specific subset of breast cancer above, which is triple negative breast cancer (estrogen receptor, progesterone receptor and HER2 negative).
With other subsets such as estrogen receptor positive or/ and HER2 positive (over-expressed), adjuvant treatments gets even more complicated with availability of many new and effective treatments, which contributes to even higher chances of cure!
Beacon Hospital CSR Program for Breast Cancer
Beacon Hospital CSR program for breast cancer is started to allow lower income breast cancer patients to seek for prompt (same day or the following day after consultation) chemotherapy treatment to avoid risk or cancer recurring or spreading.
The above RM500 for each chemotherapy cycle (6 – 8 cycles) for eligible patients will include:
- chemotherapy medications
- pre-medication (prevention of vomiting, allergy and other medications)
- take home medications (prevention of vomiting and other medications).
- daycare charges and consumables
- pre-treatment blood test
For patients who do not fulfill the above CSR program eligibility criteria, Beacon Hospital CSR department will find other ways to help our patients.