Response to chemotherapy is a very important prognostic indicator. Only four of 766 patients who had a partial response and only two of 372 patients who had no change afer chemotherapy remained free of progressive disease five years out. Of course, a treatment strategy developed in recent years has been the performance of bone marrow and stem cell transplants in an attempt to increase dose of chemotherapy, thereby hoping for a superior outcome. An accompanying editorial by Dr. Sledge of the Indiana University School of Medicine raises several important points including what the outcome differences would have been if other chemotherapies or in fact no chemotherapy was used. He points out the potential benefits of using Adriamycin as part of the combination chemotherapy regime.
Some patients clearly are alive and disease-free a decade or more after initial relapse.
The fraction may be small, but the accomplishment is not. The patient with metastatic breast cancer is in a desperate but not uniformly hopeless situation. Perhaps we might, in the not too distant future, expand the message of hope to the majority of patients with metastatic breast cancer. To do so will probably require something quite different than today's combination chemotherapy. But the dream is not an impossible one.