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Combination chemotherapy for metastatic breast cancer.Comparison of multiple drug therapy with 5-fluorouracil, cytoxan and prednisone with adriamycin or adrenalectomy

1978; Wiley; Volume: 41; Issue: 6 Linguagem: Inglês

10.1002/1097-0142(197806)41

1097-0142

Takuma Nemoto, Dutzu Rosner, R Ortega Díaz, Thomas L. Dao, Robert W. Sponzo, Thomas J. Cunningham, John Horton, Richard Simon,

Breast Cancer Treatment Studies

A prospective randomized clinical study to compare 3 treatment modalities, consisting of single-agent chemotherapy with adriamycin, adrenalectomy, and combination chemotherapy with cytoxan, 5-FU and prednisone (CFP), was carried out in 94 postmenopausal women with metastatic breast cancer. All of these patients had not received previous hormonal or cytotoxic chemotherapy, and all had measurable disease for response evaluation. Patients were randomized to one of three therapeutic arms: 1) adrenalectomy, CFP, adriamycin, in sequence, or 2) CFP, adriamycin, adrenalectomy, in sequence, or 3) adriamycin, adrenalectomy, CFP, in sequence. Objective response to initial therapy was seen in 9 of 26 adrenalectomy patients (35%), 12 of 32 adriamycin-treated patients (38%), and 13 of 30 CFP-treated patients (43%). Duration of remission was significantly better in CFP-treated patients with a median duration of 21.3 months, as compared to adrenalectomy- or adriamycin-treated patients, with median durations of 9.2 and 7.6 months, respectively. The evaluation of the overall palliative achievement of the three fixed arms, based on response to at least one modality was 13 of 26 in the adrenalectomy sequence (50%), 13 of 30 in the CFP sequence (43%), and 18 of 32 in the adriamycin sequence (56%). There was no response to secondary or tertiary therapies among patients receiving CFP as the initial treatment. The data show that combination therapy with cytotoxic and hormonal agents is superior to single-agent therapy of adrenalectomy. However, the results also disclose that there is no therapeutic advantage in using CFP as an initial therapy in women with advanced breast cancer.