Doxorubicin and Cyclophosphamide versus Cyclophosphamide,Methotrexate, and 5-Fluorouracil as Adjuvant Chemotherapy in Breast Cancer

Abstract

This study evaluated whether doxorubicin and cyclophosphamide are superior to cyclophosphamide, methotrexate and 5-fluorouracil as adjuvant chemotherapy in breast cancer patients. Between July 1976 and December 2004, 1045 breast cancer patients received adjuvant chemotherapy at the Radiotherapy Unit of the University of florence. 927 were administered i.v. CMF (cyclophosphamide 600 mg/m², methotrexate 40mg/m² and 5-fluorouracil 600 mg/m² on days 1 and 8, repeated every 28 days for a total of six cycles) and 118 i.v. DC (doxorubicin 60 mg/m2and cyclophosphamide 600 mg/m² on day 1 repeated every 21 days for a total of four cycles). All patients under-went adjuvant radiotherapy as well. The survival analysis, stratified according to treatment, did not show any significant difference in metastasis occurrence between the two groups (log rank test p=0.42). According to multivariate analysis four parameter semerged as independent prognostic factors for distant metastases in patients treated with the CMF regimen: pT (p=0.0005), number of positive axillary lymph nodes(p=<0.0001), tamoxifen use (p=0.0109) and local relapses (p=<0.0001). Only number of positive axillary lymph nodes and local relapses were significant predictors of metastases occurrence according to multivariate analysis in the DC group, 17 and p=0.028, respectively. No significant difference between the two regimens was ob-served with regards to number of involved nodes. DC and CMF produced similar out-come in breast cancer patients.