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Invasive Lobular Breast Cancer- Chemo or Not?

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 We reviewed randomized trials of neoadjuvant and adjuvant chemotherapy and noted that insufficient evidence is available to support or withhold use of chemotherapy in patients with invasive lobular breast cancer-

This article deals with the fact that, although there is little data suggesting that lobular and ductal breast cancers respond in similar ways to primary systemic chemotherapy, they are usually treated the same way.  They believe that the benefit for those with lobular breast cancer is unclear and that more study is needed.
They conclude the following:  “In view of the paucity of data on the specific role of chemotherapy for patients with invasive lobular carcinoma, the possible role of histology as a marker of tumour biology and treatment effectiveness, and the potential practical implications of cost and of short-term and long-term toxic effects of chemotherapy, we suggest that the role of histology should be more thoroughly investigated in future randomised trials, so that possible overtreatment of patients with invasive lobular carcinoma can be avoided.”
 Since most trials of neoadjuvant therapy report clinical or pathological response rates, or both, the role of chemotherapy in invasive lobular carcinoma could be assessed prospectively in such randomised trials by at least two different approaches: by comparing response rates to chemotherapy between patients with invasive ductal carcinoma and those with invasive lobular tumours; and by comparing the response rate of invasive lobular cancers with chemotherapy and with hormone treatment. In addition to the experimental setting, the role of histology could also be investigated by retrospective analysis of individual data from patients enrolled in previous randomized trials.
 Finally, besides the potential implications of our findings on future retrospective and prospective research, we suggest that treatment guidelines should reconsider current evidence about the role of chemotherapy in patients with early-stage invasive lobular carcinoma. Women with classic invasive lobular carcinoma represent a more homogeneous population—eg, with almost universal estrogen-receptor expression and frequent display of lower histological grade and proliferation index—than patients with invasive ductal carcinoma, who encompass various subgroups of expression of hormone receptors, ERBB2, and other prognostic features.”
Mary Miller Breast Cancer Profile in Courage

“Invasive lobular carcinoma is the second most frequent histological type of breast cancer and its incidence is increasing. It has unique clinical, biological, and molecular features. Invasive lobular carcinoma is almost invariably positive for the estrogen receptor and, when compared with invasive ductal carcinoma, it is typically of a lower grade.
Even though invasive lobular carcinoma represents a distinct clinical entity, the same criteria used for invasive ductal carcinoma are currently applied to establish the need for primary or adjuvant systemic chemotherapy.
We reviewed randomized trials of neoadjuvant and adjuvant chemotherapy and noted that insufficient evidence is available to support or withhold use of chemotherapy in patients with invasive lobular carcinoma. Thus, the benefit from systemic chemotherapy for individuals with this form of breast disease is unclear. Invasive lobular carcinoma deserves to be investigated separately in prospective clinical trials to define the best treatment and prevention strategies.
PMID: 17196511 [PubMed – indexed for MEDLINE]

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2 comments
Rumina says last year

I feel they should do more research on invasive lobular cancer and proper treatments. I keep on finding the same thing, not known whether chemo is helps or does not. My oncologist wants to do chemo. Also then the surgeon is saying double mastectomy thou have 2 lumps in right breast and one nodule that.is cancerous and i did research mastectomy does not prolong life or stop recurrence of cancer! Its a shame that little is known and the oncologist and surgeon want to go with drastic measures. I know the final call is what i want! It is very difficult.when so little is known about this cancer thou it is the 2nd largest after invasive ductal cancer. Myself being in the health profession is having such a hard time making desicions, i feel bad for my fellow women who i call my sisters also having to make hard desicions and may not be in the medical profession. Lobular breast cancer should be more researched!

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    David Emerson says last year

    Hi Rumina-

    I agree with you.

    David Emerson

    Reply
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