Adjuvant Breast Cancer Treatment: Evolution or Revolution?

F or years, clinicians have appreciated that breast cancer is not one disease, but a family of diseases, each with a distinct natural history and response to treatment. Yet, over the past two decades, adjuvant trials have largely enrolled patients on the basis of tumour size and lymph node status, rather than by biologic features. There were relatively few concessions to the biologic heterogeneity of breast cancer in the design of clinical trials. Admittedly, patients with hormone responsive tumours were generally given tamoxifen in addition to chemotherapy, but only a few large trials focused exclusively on questions in receptorpositive or receptor-negative cohorts.1,2 This issue of the Breast International Group (BIG) Newsletter focuses upon recent progress in adjuvant breast cancer treatment. Martine Piccart and Kathleen Pritchard review the evidence for the use of aromatase inhibitors (AI) in postmenopausal women with receptor-positive breast cancer. Maureen Trudeau discusses the role of taxanes. Brian Leyland-Jones and Soheyl Baban outline advances in genomics and proteomics. What is clear from these articles is that the care of patients with breast cancer has evolved substantially. However, if we want to achieve more dramatic advances, new and more innovative approaches to clinical trial design will be required. Adjuvant Breast Cancer Treatment: Evolution or Revolution?