title: Adjuvant Metronomic CMF in a Contemporary Breast Cancer Cohort: What's Old Is New.
abstract: BACKGROUND
  Commonly used adjuvant systemic therapies harbor high rates of severe short-term and long-term side effects but are often justified to patients because of curative intent in early-stage breast cancer. One of the oldest and least toxic adjuvant regimens, CMF (oral cyclophosphamide given with intravenous methotrexate and 5-fluorouracil), has been largely abandoned because of the perception that it underperforms for survival outcomes compared with modern regimens containing anthracycline and/or taxanes.
  
  
  METHODS
  To address this misperception, we performed a review of all consecutive breast cancer patients at the Seattle Cancer Care Alliance over the past decade who received 6 months of adjuvant CMF as their sole chemotherapy regimen and determined rates for relapse-free survival (RFS), overall survival (OS), and major organ toxicity. From January 2003 to August 2013, 248 patients (median age of 52 years at the start of chemotherapy) met criteria for inclusion in this series and had a median follow-up of 67 months.
  
  
  RESULTS
  RFS and OS at 5 years was 94.5% (91.3%-97.9%) and 98% (96%-100%), respectively. The only major organ toxicity that occurred in > 5% of patients was Grade 3 neutropenia (18.1%, 24 patients). One patient died during therapy from pneumocystis pneumonia attributed to previously undiagnosed AIDS.
  
  
  CONCLUSIONS
  In a modern cohort of patients thoroughly characterized for Grade and hormone receptor status, CMF was a well-tolerated and effective adjuvant regimen for early-stage breast cancer and should be considered for appropriately selected patients.
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Eunpi
authors.initials: E
authors.lastname: Cho
authors.affiliation: Department of Pharmacology, University of Washington, Seattle, WA.
authors.forename: Ann K
authors.initials: AK
authors.lastname: Schwemm
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA.
authors.forename: Lena M
authors.initials: LM
authors.lastname: Rubinstein
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Stevenson
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Public Health Services Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Ted A
authors.initials: TA
authors.lastname: Gooley
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Georgiana K
authors.initials: GK
authors.lastname: Ellis
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Specht
authors.affiliation: University of Arizona College of Medicine, Tucson, AZ.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Livingston
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Hannah M
authors.initials: HM
authors.lastname: Linden
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Public Health Services Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Electronic address: vkgadi@u.washington.edu.
authors.forename: Vijayakrishna K
authors.initials: VK
authors.lastname: Gadi
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D009367:Neoplasm Staging
chemical_list: D003520:Cyclophosphamide; D005472:Fluorouracil; D008727:Methotrexate
keywords: Adjuvant chemotherapy; Cyclophosphamide; Fluorouracil; Hormone-receptor positive; Methotrexate