Intravenous or oral adjuvant CMF for node-positive breast cancer.
To assess the optimal duration and method of administration of adjuvant cyclophosphamide, methotrexate and 5-fluorouracil (CMF) chemotherapy, 116 patients with positive axillary nodes after total mastectomy and axillary dissection were reviewed retrospectively. CMF was administered in three progressively shorter regimens, which consisted of oral CMF for either 12 or six cycles and intravenous (i.v.) CMF for six cycles. Median follow-up for surviving patients was 62 months. The three groups were matched for major prognostic factors. There was no advantage in using more than six cycles of adjuvant CMF. There was an improved crude 3 year disease-free survival (84 vs 65%, P = 0.05) and a trend towards improved overall survival (92 vs 85%, P = NS) in patients treated with six cycles of oral CMF compared with i.v. CMF. Survival rates were not significantly different beyond 3 years. Leucopenia and alopecia were more severe with oral CMF (P less than 0.01), and compliance worse with oral CMF x 12 (P = 0.01). Since the data suggest that i.v. CMF is at least as equal as oral CMF a randomized controlled trial should be undertaken.
Lindeman
G J
GJ
Department of Radiation Oncology, Westmead Hospital, New South Wales, Australia.
Boyages
J
J
Driessen
C
C
Langlands
A O
AO
D000277:Adjuvants, Pharmaceutic / Q000008:administration & dosage* / Q000627:therapeutic use; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000505:Alopecia / Q000139:chemically induced / Q000453:epidemiology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D007970:Leukopenia / Q000139:chemically induced / Q000453:epidemiology; D008197:Lymph Node Excision / Q000592:standards; D008207:Lymphatic Metastasis; D015413:Mastectomy, Simple / Q000592:standards; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000401:mortality; D009517:New South Wales / Q000453:epidemiology; D011379:Prognosis; D016019:Survival Analysis; D015996:Survival Rate
D000277:Adjuvants, Pharmaceutic; D003520:Cyclophosphamide; D005472:Fluorouracil; D008727:Methotrexate