A step towards individualizing chemotherapy for triple-negative breast cancer

Here's a step in the direction of individualizing chemotherapy choices.

A small study published in this month's Annals of Oncology, "Platinum-based chemotherapy in triple-negative breast cancer," supports earlier findings that women with triple-negative (TN) breast cancer may be more likely than other patients to respond to one of the platinum chemotherapy drugs, Carboplatin and Cisplatin.

In the study, the response rates of women with TN and other forms of breast cancer were compared after treatment with platinum chemotherapy. Some of these patients had locally advanced breast cancer and some were being treated for metastatic disease, but in both groups, the TN patients responded significantly better.

Annals of Oncology 2008 19(11):1847-185
Platinum-based chemotherapy in triple-negative breast cancer

B. Sirohi, Smith, I. et al. Breast Unit, Royal Marsden NHS Foundation Trust, London. E-mail for reprint: ian.smith@rmh.nhs.uk

Background: Experimental data suggest that triple-negative (TN) breast cancer may have increased sensitivity to platinum-based chemotherapy but clinical data are limited. We present our long-term results with platinum-based chemotherapy for TN breast cancer.

Patients and methods: In all, 94 (17 TN), 79 (11 TN) and 155 (34 TN) patients receiving platinum-based chemotherapy in neo-adjuvant/adjuvant and advanced setting were included. Response rates and outcome were compared for TN tumours versus others.

Results: Neo-adjuvant complete response rates were significantly higher for TN tumours (88%) than others (51%; P = 0.005). The 5-year overall survival (OS) for TN tumours following adjuvant/neo-adjuvant chemotherapy was 64% [95% confidence interval (CI) 44% to 79%] compared with 85% (95% CI 79% to 90%) for others. Five-year disease-free survival for TN tumours was 57% (95% CI 37% to 73%) compared with 72% (95% CI 64% to 78%) for others. For patients with advanced breast cancer, overall response rates were 41% for TN tumours and 31% for others (P = 0.3). Patients with TN tumours had a significantly prolonged progression-free survival of 6 months compared with 4 months for others (P = 0.05), though the OS was not significantly different between the two groups (11 versus 7 months).

Conclusion: Platinum-based chemotherapy achieves increased response rates for TN tumours, with a trend towards worse survival in early breast cancer through an improved survival in advanced disease. Prospective randomised trials are warranted.

Write your heart out!

This interesting randomized trial confirms what a lot of other research has shown: that people with all sorts of serious diseases feel better (and may even do better) when they express their strong feelings through writing. This study finding builds on a lot of prior research.

I've always felt that this is one of the unsung effects of cancer mailing lists like the BCMETS list (and bulletin boards and blogs, and of course journaling where people not only exchange information, but often write on a deep level of their experiences). Not only do people make contact with one another and feel less alone, and get good advice and information, but they have an opportunity to articlulate their deepest feelings.

Journal of Pain and Symptom Management, Volume 35, Issue 6, June 2008, Pages 623-631

Emotional Disclosure Through Patient Narrative May Improve Pain and Well-Being: Results of a Randomized Controlled Trial in Patients with Cancer Pain

M. Soledad Cepeda MD, PhD et al.

Narrative medicine is based upon physicians' awareness of patients' narration of their suffering, their hopes, and how illness has affected them. It offers a model for improving health outcomes.

To determine whether incorporating a narrative approach in patients with cancer decreases pain intensity and improves their global sense of well-being, we performed a randomized, single-blind controlled trial in adult patients with cancer and average pain intensity levels of at least 5/10.

Two hundred thirty-four patients were randomized into three groups: (1) narrative (n = 79), in which patients wrote a story about how cancer affected their lives for at least 20 minutes once a week for three weeks; (2) questionnaire (n = 77), in which patients filled out the McGill Pain Questionnaire; and (3) control (n = 78), in which patients came weekly to medical visits during which they received usual customary care. Patients rated their pain on a 0�10 scale and their well-being on a seven-point Likert scale weekly for eight weeks. Two raters independently evaluated the emotional content of the narratives.

Pain intensity and sense of well-being were similar in all groups before and after treatment.
Subgroup analyses showed that patients whose narratives had high emotional disclosure had significantly less pain and reported higher well-being scores than patients whose narratives were less emotional. Further study is needed to demonstrate whether the implementation of narrative medicine is associated with health benefits in this and other contexts.