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CMF oral regimen

Abstract: Combination chemotherapy as an adjuvant treatment in operable breast cancer.

Prolonged cyclic combination chemotherapy with cyclophosphamide, methotrexate and fluorouracil was evaluated as adjuvant treatment to radical mastectomy in primary breast cancer with positive axillary lymph nodes. After 27 months of study, treatment occurred in 24 per cent of 179 control patients and in 5.3 per cent of 207 women given combination chemotherapy (P less than 10(-6)), the advantage appearing statistically significant in all subgroups of patients. Patients with four or more positive axillary nodes had a higher per cent of relapses than those with fewer nodes. The initial new clinical manifestations occurred in distant sites in 81.5 per cent of relapsed patients. Long-term chemotherapy produced an acceptable toxicity, thus allowing the administration of a high percentage of drug dosage. These results should be considered with caution, since, at present, the effect of this therapy on survival and possible long-term side effects remain unknown.

References
Bonadonna G.  Brusamolino E.  Valagussa P.  Rossi A. Brugnatelli L.  Brambilla C.  De Lena M.  Tancini G.  Bajetta E.  Musumeci R. Veronesi U. Combination chemotherapy as an adjuvant treatment in operable breast cancer. New England Journal of Medicine.  294(8):405-10, 1976 Feb 19.

Editors Note:
This study was reported in 1976 and is regarded as a landmark study because it was one of the earliest studies to show the efficacy of combination chemotherapy and also because it was one of the earliest justifications for the use of adjuvant chemotherapy.

Regimen

Cytoxan......... 100 mg/sqm orally days 1 to 14.
Methotrexate.... 40 mg/sqm IV days 1 and 8.
Fluorouracil.... 600 mg/sqm IV days 1 and 8.
FREQUENCY....... Repeat cycle every 28 days.

     
  Summary Adjuvant CMF vs. control group (no chemotherapy)
  Disease progression 5.3% vs. 24% in the control group
     
   

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Article reviewed by:

Dr. Tamer Fouad, M.D.

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