ABSTRACT: Duration of adjuvant chemotherapy for breast cancer:
a joint analysis of two randomised trials investigating three
versus six courses of CMF
Cyclophosphamide, methotrexate and fluorouracil adjuvant combination
chemotherapy for breast cancer is currently used for the duration
of six monthly courses.
We performed a joint analysis of two
studies on the duration of adjuvant cyclophosphamide, methotrexate
and fluorouracil in patients with node-positive breast cancer to
investigate whether three courses of cyclophosphamide, methotrexate
and fluorouracil might suffice.
The International Breast Cancer
Study Group Trial VI randomly assigned 735 pre- and perimenopausal
patients to receive 'classical' cyclophosphamide, methotrexate and
fluorouracil for three consecutive cycles, or the same chemotherapy
for six consecutive cycles.
The German Breast Cancer Study Group
randomised 289 patients to receive either three or six cycles of
i.v. cyclophosphamide, methotrexate and fluorouracil day 1, 8.
Treatment effects were estimated using Cox regression analysis
stratified by clinical trial without further adjustment for covariates.
The 5-year disease-free survival per cents (+-s.e.) were 54+-2%
for three cycles and 55+-2% for six cycles (n=1024; risk ratio
(risk ratio: CMF'3/CMF'6), 1.00; 95% confidence interval,
0.85 to 1.18; P =0.99).
Use of three rather than six cycles was
demonstrated to be adequate in both studies for patients at least
40-years-old with oestrogen-receptor-positive tumours (n=594; risk
ratio, 0.86; 95% confidence interval, 0.68 to 1.08; P =0.19).
fact, results slightly favoured three cycles over six for this
subgroup, and the 95% confidence interval excluded an adverse
effect of more than 2% with respect to absolute 5-year survival.
In contrast, three cycles appeared to be possibly inferior to six
cycles for women less than 40-years-old (n=190; risk ratio, 1.25;
95% confidence interval, 0.87 to 1.80; P=0.22) and for women with
oestrogen-receptor-negative tumours (n=302; risk ratio, 1.15; 95%
confidence interval, 0.85 to 1.57; P =0.37).
Thus, three initial
cycles of adjuvant cyclophosphamide, methotrexate and fluorouracil
chemotherapy were as effective as six cycles for older patients
(40-years-old) with oestrogen-receptor-positive tumours, while
six cycles of adjuvant cyclophosphamide, methotrexate and fluorouracil
might still be required for other cohorts.
therapy with tamoxifen and GnRH analogues is now available for
younger women with oestrogen-receptor-positive tumours, the need
for six cycles of cyclophosphamide, methotrexate and fluorouracil
is unclear and requires further investigation.
[06/12/2002; British Journal of Cancer]
Ann's NOTE: As patients we need to know that the 'correct' dose schedule for any chemotherapy is unknown. If you suggest that a particular individual needs a specific schedule, that is wholly unexplored.
But this study demonstrates that although CMF has been given for 6 cycles, it is now shown that 3 cycles may be BETTER for women OVER 40 with Estrogen Receptor Positive tumors.
This is very interesting because one of the reasons to approve use of anthracycline chemotherapy, even though it is MUCH more toxic to the heart, was that is was only given for 4 cycles NOT 6 as with CMF.
JCNI Cancer Spectrum
JNCI Cancer Spectrum, 7/02
Lancet 2009; 373: 1681-92.
|Remember we are NOT Doctors and have NO medical training.|
This site is like an Encyclopedia - there are many pages, many links on many topics.
Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.