Transcript Early Breast Cancer Trialists` Collaborative Group (EBCTCG

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
BACKGROUND
• Background Quinquennial overviews(19852000) of the randomized trails in early
breast cancer have assessed the 5-year and
10-year effects of various systemic adjuvant
therapies on breast cancer recurrence and
survival.
• Reporting 10-year and 15-year effects
BACKGROUND
• The Early Breast Cancer Trialists’
Collaborative Group coordinated the
world's largest collaborative analysis of
cancer trials, bringing together data
from 145,000 women with early
METHODS
• Collaborative meta-analyses were
undertaken of 194 unconfounded
randomised trails of adjuvant chemotherpay
or hormonal therapy that began by 1995
• Trails involved CMF(cyclophosphomide,
methotrexate, fluorouracil), anthracyclinebased combinations such as FAC, FEC,
Tamoxifen, or ovarian suppression:none
involved taxanes, trastuzumab, raloxifene
RESULTS
• Finding Allocation to about 6 months of
anthracycline-based chemotherapy reduces
annual breast cancer death rate by about
38% <50 yrs women, 20% >50-69
• More significant thant CMF therapy
RESULTS
• that were being tested in the 1980s, and
have since been widely used, such as 6
months of
• anthracycline-based chemotherapy (in
which an anthracycline is combined with
two older drugs, .uorouracil and
cyclophosphamide) and 5 years of
tamoxifen.
Results
• The investigators found that where both
chemotherapy and hormonal therapy
are appropriate they can approximately
halve the 15-year risk of death from
breast cancer.
RESULTS
• if a 50-year-old women had a one in 5
risk of dying from her hormone-sensitive
breast cancer, then this risk could be
halved, to about one in 10.
• For middle-aged wome with breast
cancer, 6 months of anthracyclinebased chemotherapy reduces the
breast cancer death rate over the next
10 or 15 years by about one third.
RESULTS
• For women of any age with hormonesensitive early breast cancer, the
commonest form of the disease, 5 years
of tamoxifen also reduces the breast
cancer death rate over the next 10 or 15
years by about one third
INTERPRETATION
• Some of the widely practicable adjuvant
drug treatments that were being tested in the
1980’s which substantially reduced 5 year
recurrence rates(bu had somewhat less
effect on 5-year mortality rates)
• Also substantially reduce 15-year mortality
rates
Primary Validity Guidelines
• Was the assignment of the patients
randomized?
Yes.
Primary Validity Guidelines
• Were all patients who entered the trial
accounted for at its conclusion?
Yes.
Primary Validity Guidelines
• Was the follow-up complete?
Yes.
Primary Validity Guidelines
• Were the patients analyzed in groups to which
they were randomized?
Yes.
Secondary Validity Guidelines
• Were the patients and health workers blind to
the treatment?
Yes.
Secondary Validity Guidelines
• Were the groups similar at the start of the trial?
Yes.
Secondary Validity Guidelines
• Aside from the experimental intervention,
were the groups treated equally?
Yes.