Author/Editor		Colleoni, M; Litman, HJ; Castiglione-Gertsch, M; Sauerbrei, W; Gelber, RD; Bonetti, M; Coates, AS; Schumacher, M; Bastert, G; Lindtner, J
Title		Duration of adjuvant chemotherapy for breast cancer: a joint analysis of two randomised trials investigating three versus six courses of CMF
Type		članek
Source		Br J Cancer
Vol. and No.		Letnik 86, št. 11
Publication year		2002
Volume		str. 1705-14
Language		eng
Abstract		Cyclophosphamide, methotrexate and fluorouracil adjuvant combination chemotherapy for breast cancer is currently used for the duration of six monthly courses. We performed a joint analysis of two studies on the duration of adjuvant cyclophosphamide, methotrexate and fluorouracil in patients with node-positive breast cancer to investigate whether three courses of cyclophosphamide, methotrexate and fluorouracil might suffice. The International Breast Cancer Study Group Trial VI randomly assigned 735 pre- and perimenopausal patients to receive 'classical' cyclophosphamide, methotrexate and fluorouracil for three consecutive cycles, or the same chemotherapy for six consecutive cycles. The German Breast Cancer Study Group randomised 289 patients to receive either three or six cycles of i.v. cyclophosphamide, methotrexate and fluorouracil day 1, 8. Treatment effects were estimated using Cox regression analysis stratified by clinical trial without further adjustment for covariates. The 5-year disease-free survival per cents (+/-s.e.) were 54+/-2% for three cycles and 55+/-2% for six cycles (n=1024; risk ratio (risk ratio: CMFx3/CMFx6), 1.00; 95% confidence interval, 0.85 to 1.18; P=0.99). Use of three rather than six cycles was demonstrated to be adequate in both studies for patients at least 40-years-old with oestrogen-receptor-positive tumours (n=594; risk ratio, 0.86; 95% confidence interval, 0.68 to 1.08; P=0.19). In fact, results slightly favoured three cycles over six for this subgroup, and the 95% confidence interval excluded an adverse effect of more than 2% with respect to absolute 5-year survival. In contrast, three cycles appeared to be possibly inferior to six cycles for women less than 40-years-old (n=190; risk ratio, 1.25; 95% confidence interval, 0.87 to 1.80; P=0.22) and for women with oestrogen-receptor-negative tumours (n=302; risk ratio, 1.15; 95% confidence interval, 0.85 to 1.57; P=0.37). (Abstract truncated at 2000 characters)
Descriptors		BREAST NEOPLASMS ANTINEOPLASTIC AGENTS, COMBINED CYCLOPHOSPHAMIDE FLUOROURACIL METHOTREXATE ADULT MIDDLE AGE CHEMOTHERAPY, ADJUVANT DISEASE-FREE SURVIVAL DRUG ADMINISTRATION SCHEDULE MENOPAUSE PREMENOPAUSE SURVIVAL RATE TIME FACTORS