Premium
Randomized trial comparing cyclophosphamide, methotrexate, and 5–fluorouracil (CMF) with rotational CMF, epirubicin and vincristine as primary chemotherapy in operable breast carcinoma
Author(s) -
Cocconi Giorgio,
Blasio Beatrice Di,
Boni Corrado,
Bisagni Giancarlo,
Ceci Guido,
Rondini Ermanno,
Bella Mariangela,
Leonardi Francesco,
Savoldi Luisa,
Camisa Roberta,
Bruzzi Paolo
Publication year - 2002
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.10678
Subject(s) - epirubicin , medicine , regimen , vincristine , cyclophosphamide , chemotherapy , breast cancer , fluorouracil , tamoxifen , anthracycline , randomized controlled trial , oncology , methotrexate , surgery , cancer
BACKGROUND According to the overview of Early Breast Cancer Trialists' Collaborative Group, anthracycline containing regimens are superior to cyclophosphamide, methotrexate, and 5–fluorouracil (CMF) as adjuvant chemotherapy for breast carcinoma, but no comparative information is available in terms of primary chemotherapy. In the current randomized controlled trial, the authors compared CMF with a chemotherapy regimen including CMF, epirubicin, and vincristine (CMFEV). METHODS Two hundred eleven patients with Stages I and II palpable breast carcinoma and tumor diameter > 2.5 cm or ≤ 2.5 cm with cytologically proven axillary lymph node involvement were randomized to receive CMF (arm A) or CMFEV regimen (arm B) for four cycles before surgery. After surgery, patients in both arms received adjuvant CMF for three cycles; the postmenopausal patients also received tamoxifen for two years. RESULTS There were no significant differences in the complete response (CR) and in the CR plus partial response (PR) rates between the two arms. In the subset analysis, among premenopausal patients, significantly higher rates of CR (26% vs 4%, P = 0.004) and of CR + PR rates (80% vs 54%, P = 0.007) were observed in the CMFEV, as compared to the CMF arm. Multivariate analysis confirmed the presence of a significant interaction between menopausal status and type of treatment on the probability of achieving CR ( P = 0.02) or CR + PR ( P = 0.01). There were no major differences in the side effects of the two treatments, with the exception of more frequent alopecia in the experimental arm. CONCLUSIONS The results of the current study are in line with those of previous published randomized clinical trials comparing regimens without and with anthracycline as adjuvant treatment, indicating an agreement between the short term response to primary chemotherapy and the long term results observed in the adjuvant setting. Cancer 2002;95:228–35. © 2002 American Cancer Society. DOI 10.1002/cncr.10678