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Annals of Oncology Advance Access published online on June 14, 2005
Annals of Oncology, doi:10.1093/annonc/mdi278
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© 2005 European Society for Medical Oncology
Received February 1, 2005
Revised April 22, 2005
Accepted April 25, 2005

Original article

Primary chemotherapy in operable breast carcinoma comparing CMF (cyclophosphamide, methotrexate, 5-fluorouracil) with an anthracycline-containing regimen: short-term responses translated into long-term outcomes

G. Cocconi 1*, B. Di Blasio 1, C. Boni 2, G. Bisagni 2, E. Rondini 2, M. A. Bella 1, F. Leonardi 1, L. Savoldi 2, C. Vallisneri 1, R. Camisa 1, P. Bruzzi 3, and On behalf of the Italian Oncology Group for Clinical Research (GOIRC), Parma, Italy

1 Medical Oncology Division, Azienda Ospedaliera Universitaria of Parma, Italy
2 Medical Oncology Service, Azienda Ospedaliera, Reggio Emilia, Italy
3 Istituto Nazionale per la Ricerca sul Cancro, Largo Rosanna Benzi 10, Genova, Italy

* To whom correspondence should be addressed.
G. Cocconi, E-mail: giorgio.cocconi{at}tin.it


  Abstract

Background: The role of anthracyclines has been extensively studied in adjuvant chemotherapy, but much less in the primary chemotherapy of early breast carcinoma. This study, comparing CMF (cyclophosphamide, methotrexate, 5-fluorouracil) with the rotational anthracycline-containing regimen CMFEV (CMF plus epirubicin and vincristine) administered as primary chemotherapy, demonstrated a significant increase in clinical complete response in premenopausal women. We report the long-term results.

Patients and methods: Two hundred and eleven patients with stage I or II palpable breast carcinoma and a tumour diameter of >2.5 cm were randomised to receive CMF or CMFEV for four cycles before surgery. After surgery, the patients in both arms received adjuvant CMF for three cycles.

Results: In the study population as a whole, there was a non-significant 20% reduction in mortality and relapse rates in the CMFEV arm. However, the effect of the experimental regimen was only found in premenopausal patients, especially in terms of relapse-free survival (P=0.07) and locoregional relapse-free survival (P=0.0009), thus mirroring the effect on response rates. After 10 years, the proportions of premenopausal patients free from locoregional relapse as a first event in the CMF and CMFEV groups were 68% and 97%, respectively. No relevant differences were found in postmenopausal patients.

Conclusion: The overall results of this study showed that the greater activity of the experimental anthracycline-containing combination over CMF as primary chemotherapy in premenopausal patients translated into long-term effects in the same subgroup.

Keywords: anthracycline; breast carcinoma; CMF; complete response; outcome; primary chemotherapy.
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