NEW CLINICAL TRENDS IN THE ADJUVANT THERAPY OF EARLY-STAGE BREAST-CANCER

Recent clinical trials of adjuvant therapy for early stage breast canc er support two general observations. First, overall survival is not im pacted by the extent of surgery. Low rates of axillary relapse in pati ents treated with total mastectomy alone combined with the availabilit y of systemic therapy as a substitute for surgical control of the axil la mean that patients can often be spared the morbidity of axillary no de dissection. In problematic cases, newer diagnostic approaches, such as sentinel node biopsy, can help in making appropriate treatment dec isions. Second, systemic therapy can reduce the clinical manifestation s of disease. The incorporation of more sophisticated approaches to pr edicting outcomes, to varying timing and dose of treatment, and to dev eloping new modalities of treatment, including immunotherapy, will con tribute to a general strategy aimed at reducing the tumor to a harmles s parasite. These observations support a paradigm shift in our definit ion of 'adjuvant'. Rather than referring to the use of systemic therap y after the patient's known disease has been surgically removed, adjuv ant therapy would be re-defined to refer to local therapy used to erad icate any residual tumor remaining after systemic therapy has been com pleted.