A follow-up study of hundreds of pre-menopausal patients treated for early stage breast cancer at M. D. Anderson Cancer Center found that partial use of paclitaxel (Taxol) with standard adjuvant chemotherapy significantly improved a younger woman's chance that she could regain her ovarian function.

The standard chemotherapy regimen, known as FAC, includes adriamycin and cyclophosphamide with or without 5-fluorouracil.

The analysis, culled from a larger study of 580 breast cancer patients, compared ovarian function and outcomes in younger women who received eight rounds of FAC versus patients who received four rounds of FAC followed by four rounds of paclitaxel.

In a group of 29 women who received just FAC treatment, 20 women (69 percent) had permanent loss of ovarian function, six women (21 percent) had a transient loss of ovarian function, and three patients (10 percent) never lost it.

But in 59 women who had been treated with the "four plus four" regimen, 28 patients (47 percent) lost use of their ovaries, while 26 patients (44 percent) had a transient lost, and 5 patients (8 percent) never lost ovarian function.

Four women who used paclitaxel subsequently became pregnant, compared to just one patient treated only with FAC, reports Nuhad K. Ibrahim, M.D., associate professor of breast medical oncology at M.D. Anderson, who led the study.

The results are important because, at M. D. Anderson, up to half of all breast cancer patients treated are younger than 50 years old, says Ibrahim.

"This is not just an issue of fertility, but also of maintaining other healthy issues that are usually associated with premature menopause, such as osteoporosis, an increase of lipids in the blood stream and associated heart diseases, as well as sexual and cognitive health.

"If the clinical outcome between the patients treated with FAC alone or with FAC and paclitaxel is equivalent, then there is no reason not to offer the paclitaxel-based regimen for the patients who desire to preserve fertility, or to delay premature menopause," Ibrahim says.

SOURCES:
Annual meeting of the American Society of Clinical Oncology, June 3, 2003, Chicago, IL
University of Texas M.D. Anderson Cancer Center (http://www.mdanderson.org)