Symposium on the management of early breast cancer (stages I and II). Part II: Clinical experience with treatment methods. 4. Adjuvant chemoimmunotherapy.

The data on adjuvant chemotherapy for mammary carcinoma obtained from animal models suggest that (a) systemic chemotherapy combined with tumour excision provides more long-term cures than either method alone, (b) systemic treatment may be effective in eradicating occult micrometastases and (c) the effect of systemic chemotherapy decreases with advancing tumour stage preoperatively, with increasing time lag between operation and chemotherapy, and as the drug dosage decreases. Results from major clinical trials in terms of disease-free and overall survival differ with varying regimens in different subsets of patients, in relation to age, menopausal status and degree of pathologic axillary node involvement. Clearly, different regimens have a favourable impact on short-term disease-free survival, primarily but not exclusively in premenopausal patients. Long-term effects of such treatments on survival and late toxicity require careful continuing evaluation. The current delay in most cooperative group trials of several weeks between operation and adjuvant chemotherapy is disadvantageous. A prospective evaluation should be carried out of chemotherapy begun immediately after operation.