Abstract
849 Background: After the 1991 publication from Milan showing the advantage of A=> CMF compared to alternating CMF/A therapy, we elected to treat women with intermediate risk stage II breast cancer, with a similar combination. The objective of the study was to assess the effectiveness and tolerability of a modified A=> CMF regimen. Methods: From August 1991 till January 2003, 136 breast cancer patients, median age 45y (range 24–70) with T 1–2 N>3 (66 pts) or if less (70 pts), have at least two out of the following bad prognostic markers: very young age, negative receptors, grade III and vascular invasion. Grade I, II or III Infiltrating duct was noted in 8, 70 and 33 of the specimens respectively and positive receptors were detected in 78 of the tumors. The modified treatment was Doxorubicin (A) 75mg/M2 Q 21D × 4 followed by Cyclophosphamide 600mg/M2, Methotrexate 40mg/M2 and 5 Fluorouracyl 600mg/M2 day 1,8 Q 28D × 4. 122 patients were treated with local radiotherapy: All pts after conservative surgery and post mastectomy when 4 or more axillary nodes were positive. Hormone therapy was recommended based on receptor status. Results: There was no treatment related death. 16 patients were hospitalized for neutropenic fever and 3 for other infectious complications (<2% of the cycles). 1 pt developed secondary leukemia 24 months from end of chemotherapy. No clinical cardiac toxicity was noted. After a median follow up of 77 months from diagnosis (10 -146) 36 patients relapsed and 21 died. The disease free survival is 73% and the overall survival is 84%. Conclusions: The use of A=> CMF for node positive breast cancer is feasible, safe and very effective when compared to other modern regimens. In parts of Europe this regimen remains the standard of care for the treatment of intermediate risk breast cancer. No significant financial relationships to disclose.
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