Timing of CMF chemotherapy in combination with tamoxifen in postmenopausal women with breast cancer: role of endocrine responsiveness of the tumor.

• BACKGROUND: Controversy persists about whether chemotherapy benefits all breast cancer patients. PATIENTS AND METHODS: In the International Breast Cancer Study Group (IBCSG) trial VII, 1212 postmenopausal patients with node-positive disease were randomized to receive tamoxifen for 5 years or tamoxifen plus three concurrent courses of cyclophosphamide, methotrexate and 5-fluorouracil ('classical' CMF) chemotherapy, either early, delayed or both. In IBCSG trial IX, 1669 postmenopausal patients with node-negative disease were randomized to receive either tamoxifen alone or three courses of adjuvant classical CMF prior to tamoxifen. Results were assessed according to estrogen receptor (ER) content of the primary tumor. RESULTS: For patients with node-positive, ER-positive disease, adding CMF either early, delayed or both reduced the risk of relapse by 21% (P=0.06), 26% (P=0.02) and 25% (P=0.02), respectively, compared with tamoxifen alone. There was no difference in disease-free survival when CMF was given prior to tamoxifen in patients with node-negative, ER-positive tumors. CONCLUSIONS: CMF given concurrently (early, delayed or both) with tamoxifen was more effective than tamoxifen alone for patients with node-positive, endocrine-responsive breast cancer, supporting late administration of chemotherapy even after commencement of tamoxifen. In contrast, sequential CMF and tamoxifen for patients with node-negative, endocrine-responsive disease was ineffective.

Keyword

Adult

Aged

Aged

80 and over

Antineoplastic Combined Chemotherapy Protocols

therapeutic use

Breast Neoplasms

drug therapy

mortality

surgery

Confidence Intervals

Cyclophosphamide

therapeutic use

Dose-Response Relationship

Drug

Drug Administration Schedule

Drug Therapy

Combination

Female

Fluorouracil

therapeutic use

Humans

Mastectomy

Segmental

Methotrexate

therapeutic use

Middle Aged

Neoplasms

Hormone-Dependent

drug therapy

mortality

surgery

Postmenopause

Probability

Prognosis

Reference Values

Risk Assessment

Survival Rate

Tamoxifen

therapeutic use

Time Factors

Treatment Outcome

Publication and Content Type

ref (subject category)

art (subject category)