Annals of Oncology 9:489-493, 1998
© 1998 European Society for Medical Oncology
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Adding adjuvant CMF chemotherapy to either radiotherapy or tamoxifen: Are all CMFs alike?*
1Department of Medical Oncology, European Institute of Oncology Milan, Italy
2Australian New Zealand Breast Cancer Trials Group, Department of Medicine, University of Sydney, Royal Prince Alfred Hospital Sydney, NSW, Australia
3International Breast Cancer Study Group Coordination Center Bern, Switzerland
4International Breast Cancer Study Group Statistical Center, Dana Farber Cancer Institute, and Frontier Science and Technology Research Foundation Boston, MA, USA
Correspondence to: Aron Goldhirsch, MD International Breast Cancer Study Group Department of Medical Oncology and Radiation Oncology European Institute of Oncology Via Ripamonti 435 20141 Milan Italy E-mail: agoldhirsch{at}sakk.ch
The first reported effective adjuvant combination regimen for patients with operable breast cancer comprised oral cyclo-phosphamide (C) days 1–14 with intravenous methotrexate (M) and fluorouracil (F) on days 1 and 8, repeated every 28 days (‘classical’ CMF). These drugs have since been extensively used with or without endocrine therapies and/or other cytotoxics, as well as with radiation therapy to the chest wall yielding conflicting results. Although doses and schedules have varied widely, the combination of these three drugs has been generically referred to as CMF. Evidence exists that reducing the dose and/or altering the schedule of CMF (‘modified’ CMF) have compromised its efficacy in metastatic breast cancer.
Reduction below standard dose of a similar regimen also gave inferior results in the adjuvant setting. In fact, the recently reported improved outcome of adding radiation therapy to CMF was only demonstrated in comparisons with a ‘modified’ CMF. Furthermore, trials in women with estrogen receptor-positive breast cancer, which did not demonstrate any significant benefit for the addition of adjuvant CMF to tamoxifen compared with tamoxifen alone, also used ‘modified’ CMF. Therefore, adherence to the ‘classical’ dose and schedule is recommended when CMF is used in adjuvant therapy.
adjuvant chemotherapy, breast cancer, CMF, radiotherapy, tamoxifen
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