LACK OF EFFECTIVENESS OF ADJUVANT ALTERNATING CHEMOTHERAPY IN NODE-POSITIVE, ESTROGEN-RECEPTOR-NEGATIVE PREMENOPAUSAL BREAST-CANCER PATIENTS - RESULTS OF A MULTICENTRIC ITALIAN STUDY
F. Boccardo et al., LACK OF EFFECTIVENESS OF ADJUVANT ALTERNATING CHEMOTHERAPY IN NODE-POSITIVE, ESTROGEN-RECEPTOR-NEGATIVE PREMENOPAUSAL BREAST-CANCER PATIENTS - RESULTS OF A MULTICENTRIC ITALIAN STUDY, Cancer investigation, 15(6), 1997, pp. 505-512
A multicentric randomized trial was performed in premenopausal women w
ith node-positive, estrogen-receptor-negative breast tumors to assess
the potential superiority of alternating adjuvant chemotherapy over 's
tandard' CMF chemotherapy. Between January 1989 and June 1992, 107 pat
ients were entered into the study and randomly allocated to receive ei
ther cyclophosphamide 100 mg/m(2) per os on days 1-14, methotrexate 40
mg/m(2) and 5-fluorouracil 600 mg/m(2) intravenously (IV) on days 1,
8 (CMF), every 4 weeks for a total of 6 cycles, or the following regim
ens: CMF as previously, epidoxorubicin 75 mg/m(2) IV on day 1 and vinc
ristine 0.75 mg/m(2) IV on days 1, 8 (EV); mitomycin-C 10 mg/m(2) IV o
n day 1 and vindesine 2 mg/m(2) IV on days 1, 8 (MVs). The three regim
ens were given every 4 weeks for a total of 6 cycles according to the
following schedule: CMF, EV, MVs, CMF, EV, MVs. At a median follow up
to 48 months (range 30-72), 40 patients have relapsed and 17 have died
overall. More patients in the triple-combination arm have relapsed an
d more have died, the latter difference tending toward statistical sig
nificance (p = 0.06). There was no statistical difference in the site
of elapse between the two groups. Total duration of adjuvant therapy w
as similar in the two arms (312 chemotherapy cycles in the triple arm
and 308 in the CMF arm). Treatment toxicity was also comparable, altho
ugh more patients in the triple-combination arm were still regularly m
enstruating 6 months after the completion of chemotherapy. This study
failed to show any advantage ensuing from the use of alternating chemo
therapy in patients with early breast cancer.