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Fifty Year Review of Systemic Therapy

Posted 6/1/2014

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  Fifty years has brought many changes and improvements to systemic therapy for breast cancer. Fifty years ago, there was no such thing as endocrine/hormonal therapy or any of the drugs that are commonly used in chemo now or, certainly even the concept of targeted therapies. Just as important as the relative unsophistication of treatments are the enormous advances in symptom control and patient comfort.

  When chemo was first being given (and the first was mustard, evolved from military mustard gas), patients were generally hospitalized for the duration and quite miserably ill. When I began to work in the field in 1979, there were some effective chemotherapy drugs,but there were not good anti-nausea drugs. When patients left the Infusion Area, they were given emesis basins and generally had not even made it to their cars before the vomiting began. I heard many horror stories of nights spent on the bathroom floor. As you know, now most patients never vomit, and many have even low level nausea well controlled with drugs.

  This is an excellent review artice by Dr. Herold Burstein from DFCI; it is included in this year's ASCO Educational Book. If you have a few minutes to read this review of systemic therapy for breast cancer over the past fifty years, it is well worth your time. Here is the introduction and a link:

Fifty Years of Systemic Therapy for Breast Cancer: From One Size Fits All to Tailored Therapy
Authors: Harold J. Burstein, MD, PhD


Breast cancer treatment has evolved dramatically in the past 50 years. In addition to innovations in medical therapy—including widespread use of endocrine treatments, chemotherapy, and anti-HER2 agents—medical advances in genetic testing, imaging, and screening have revolutionized care. As profound as these changes in medical treatment have been, however, they are matched by a cultural transformation in the way society understands, discusses, and cares about breast cancer. Breast cancer has evolved from an unnamed affliction to a disease that is regularly featured on the front page of the newspapers, and is discussed in countless forums in traditional and social media. Clinical specialization in breast cancer among oncologists has given patients access to dedicated specialists around the country. These transformations will be highlighted through the analysis of a patient, Rachel Carson, who died 50 years ago from breast cancer.




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