| Long-Running Study Shows 15-Years Survival Gains in Early Breast Cancer |
by David
W. Sharp
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| WHAT'S
HOT IN MEDICINE |
| Rank |
Paper |
Citations
This Period (Mar-Apr 07) |
Rank
Last Period (Jan-Feb 07) |
| 1 |
Early Breast Cancer Trialists’ Collaborative
Group (EBCTCG), "Effects of chemotherapy and
hormonal therapy for early
breast cancer on
recurrence and 15-year survival: an overview of the randomised trials,"
Lancet, 365(9472): 1687-1717, 14 May 2005. [c. 150 institutions
worldwide] *925VV |
58 |
3 |
| 2 |
J.A.
Lieberman, et al., "Effectiveness of antipsychotic drugs in
patients with chronic
schizophrenia,"
New Engl. J. Med., 353(12): 1209-23, 22 September 2005. [8 U.S.
institutions] *966DS |
49 |
1 |
| 3 |
F.A. Shepherd, et al., "Erlotinib in
previously treated non-small-cell lung cancer," New Engl. J. Med.,
353(2): 123-32, 14 July 2005. [15 institutions worldwide] *944OP |
48 |
5 |
| 4 |
I. Iakovou, et al., "Incidence,
predictors, and outcome of thrombosis after successful implantation of
drug-eluting stents," JAMA, 293(17): 2126-30, 4 May 2005. [5
Italian and German institutions] *922AO |
41 |
† |
| 5 |
C.L. Ogden, et al., "Prevalence of
overweight and obesity in
the United States, 1999-2004," JAMA, 295(13): 1549-55, 5 April
2006. [Ctrs. for Disease Control, Atlanta, GA] *028RG |
41 |
† |
| 6 |
M.J. Piccart-Gebhart, et al., "Trastuzumab
after adjuvant chemotherapy in HER2-positive breast cancer," New
Engl. J. Med., 353(16): 1659-72, 20 October 2005. [26 institutions
worldwide] *975IC |
38 |
† |
| 7 |
E.H. Romond, et al., "Trastuzumab
plus adjuvant chemotherapy for operable HER2-positive breast cancer,"
New Engl. J. Med., 353(16): 1673-84, 20 October 2005. [19 U.S.
institutions] *975IC |
35 |
† |
| 8 |
R.J. Klein, et al., "Complement
factor H polymorphism in age-related macular degeneration," Science,
308(5720): 385-9, 15 April 2005. [6 U.S. institutions] *917TL |
33 |
4 |
| 9 |
C. Baigent, et al. (Cholesterol
Treatment Trialists’ [CTT] Collaborators), "Efficacy and safety of
cholesterol-lowering treatment: prospective meta-analysis of data from 90
056 participants in 14 randomised trials of statins," Lancet,
366(9493): 1267-78, 8 October 2005. [Correspond. addresses: Clin. Trial Serv.
Unit and Epidem. Stud. Unit, Oxford, U.K.; Natl. Hlth. & Med. Res. Council
Clin. Trials Ctr., Sydney, Australia] *971st |
33 |
† |
| 10 |
J.A. Dormandy, et al., "Secondary
prevention of macrovascular events in patients with type 2 diabetes in the
PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular
Events): a randomised controlled trial," Lancet, 366(9493):
1279-89, 8 October 2005. [13 U.S. and European institutions] *971ST |
31 |
† |
SOURCE:
Thomson Scientific's Hot
Papers Database.
Read
the Legend. |
 ore
than 20 years ago, lead investigators in randomized trials in early
breast cancer
agreed that every five years the data from individual patients would be
pooled and reanalyzed in a series of "overviews." That this agreement,
known as the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG),
has had a profound effect on clinical practice and on patients is
suggested both by the appearance of authoritative guidelines that draw
heavily on EBCTCG findings and by a total of more than 10,000 citations
to the various reports. The fourth of these overviews has reached a
citation pinnacle (#1). This paper looks at adjuvant chemotherapy and
hormonal therapy (mainly
tamoxifen). A companion article, focusing on local treatment—i.e., the
surgical and radiotherapeutic aspects of the management of patients with
this cancer—appeared seven months later (EBCTCG, Lancet,
366 [9503]: 2087-106, 2005; 21 citations this bimonthly period, with 116
total to date, compared with paper #1’s 400+ citations as of mid-summer
2007).
This long-standing collaboration, which currently has
access to data on 350,000 women randomized in 400 clinical trials,
provides statistically powerful evidence on the benefits and risks, at
around the 15-year mark, of treatments being looked at from the 1980s.
Typically the systemic (as opposed to local) treatments were six months
or so of treatment with triple drug combinations of fluorouracil and
cyclophosphamide plus either doxorubicin (Adriamycin) or epirubicin and
longer-term tamoxifen. As the EBCTCG concedes, "there is ample room for
better drugs… and for better use of existing drugs." This is despite the
evidence that the longer-established regimens can halve the annual death
rate of estrogen-receptor positive breast cancers, the most important,
but far from the only, result of this multidimensional study. The
halving of breast cancer mortality in countries such as the U.S.A and
the U.K. since the 1980s has come about through a succession of modest
improvements reliably recognized by large-scale randomized evidence. The
mortality benefits of polychemotherapy have widened with time, being
twice as good at the 15-year mark as they had been at five years; for
tamoxifen the differential is even greater.
Clinicians today are also interested in looking at
different treatments such as taxanes, selective estrogen-receptor
inhibitors, aromatase inhibitors, and trastuzumab, which were not
available when these trials began. Also, the notion that cancer
treatments should be tailored to the molecular and genetic make-up of
the patient and her tumor is attracting attention. Are reliable answers
to important clinical questions about the newer drugs and about more
molecularly sensitive approaches going to take another 15 to 20 years?
"Where next for EBCTCG?" seemed an appropriate question, so Science
Watch posed it and Prof. Richard Peto, one of the founders of EBCTCB,
kindly replied. "There are at least as many opportunities now for the
EBCTCG as there have been in the past," he told Science Watch,
"and at least as much prospect of further survival improvement for women
with breast cancer." Topics that the Group is currently addressing, he
noted, include the effect of very intensive chemotherapy and ways of
minimizing the fatal side-effects of radiotherapy. "Trials of newer
drugs will also soon be sufficiently mature for consideration within the
EBCTCG framework," added Dr. Sarah Darby, another member of the EBCTCG
Secretariat in Oxford, U.K.
Mr. David W.
Sharp, M.A. (Cambridge), formerly deputy editor of The Lancet,
is a freelance writer in Minchinhampton, U.K.
Science
Watch®, September/October 2007, Vol. 18, No. 5
Citing URL:
http://www.sciencewatch.com/sept-oct2007/sw_sept-oct2007_page5.htm |
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