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Annals of Oncology 13:1378-1386, 2002
© 2002 European Society for Medical Oncology

Original Paper

Patterns of failure in a randomized trial of adjuvant chemotherapy in postmenopausal patients with early breast cancer treated with tamoxifen

R. Arriagada1,2, M. Spielmann1, S. Koscielny1, T. Le Chevalier1, T. Delozier3, M. Ducourtieux2, T. Tursz1 and C. Hill1,+

1 Institut Gustave-Roussy, Villejuif, France; 2 Instituto de Radiomedicina, Santiago, Chile; 3 Centre François Baclesse, Caen, France

Received 15 May 2002; revised 30 May 2002; accepted 4 June 2002

Background:

We studied the effect of adjuvant anthracycline-based chemotherapy in postmenopausal patients with resected early breast cancer treated with adjuvant tamoxifen.

Patients and methods:

The trial included 835 patients with either axillary lymph node involvement, or tumors with histological grade II or III. They were randomized after local surgery to receive either tamoxifen (TAM group) or tamoxifen plus chemotherapy (TAM-CT group) consisting of six courses of 5-fluorouracil, doxorubicin and cyclophosphamide (FAC), or 5-fluorouracil, epidoxorubicin and cyclophosphamide (FEC). Radiotherapy was given after completion of adjuvant chemotherapy in the TAM-CT group and after surgery in the TAM group.

Results:

The 5-year disease-free survival (DFS) rates were 73% in the TAM group and 79% in the TAM-CT group (log-rank test, P = 0.06). The 5-year overall survival rates were 82% and 87%, respectively (P = 0.06). The 5-year distant metastasis rates were 22% and 16% (P = 0.02), and the 5-year local recurrence rates were 6% and 4%, respectively (P = 0.23). There were no significant differences for contralateral breast cancer or other new primary malignancies. Chemotherapy tended to be more effective for patients who had tumors without estrogen receptors (trend test, P = 0.05).

Conclusions:

Anthracycline-based chemotherapy administered to postmenopausal patients receiving adjuvant tamoxifen gave a borderline significant benefit on overall and DFS, mainly by a reduction in distant metastases. Delaying radiotherapy after six courses of chemotherapy did not affect local control after up to 10 years of follow-up.

Key words: adjuvant chemotherapy, adjuvant tamoxifen, early breast cancer, postmenopausal patients, randomized trial


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