SABCS 2012

Adjuvant chemotherapy for locally recurrent breast cancer

Dr Stefan Aebi – Luzerner Kantonsspital, Switzerland

CALOR was a trial that investigated the value of adjuvant chemotherapy for patients who had an isolated, this is non-metastatic, local recurrence of breast cancer. We found that chemotherapy did improve the prognosis of these patients. It was a randomised clinical trial so half of the patients would get any therapy necessary except chemotherapy and the others would get the same standard therapies plus chemotherapy. We had 162 patients overall.

What was the outcome?

The outcomes were such that in terms of disease free survival we had an improvement by an absolute 12% at five years. Overall survival, this is risk of death, we also had 12% fewer deaths, an absolute difference of 12% at five years. Since these patients, many of them, had had prior chemotherapies and we made the experience that two oncologists have three opinions on what to do, we asked the oncologists to choose something sensible. So we recommended use two drugs, use them for 3-6 months but what exactly they did was left to the discretion of the investigators. The implication is that we will be much more inclined to recommend chemotherapy, or many of us would actually consider chemotherapy as a standard for the adjuvant treatment for patients with an isolated local recurrence of breast cancer.

Does the low number of patients have an impact?

There is a low number of patients but the usual statistical power issue does not apply here because we had a statistically significant difference. So it’s a moot question to ask whether these were not enough patients. They were enough to detect a difference as big as we detected.