Adjuvant chemoendocrine therapy in postmenopausal breast cancer: Cyclophosphamide, methotrexate, and fluorouracil dose and schedule may make a difference
Adjuvant chemoendocrine therapy in postmenopausal breast cancer: Cyclophosphamide, methotrexate, and fluorouracil dose and schedule may make a difference
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DOI：
10.1200/jco.1998.16.4.1358
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发表时间：
1998-04-01
影响因子：
45.3
通讯作者：
Gelber, RD
中科院分区：
文献类型：
--
作者：
Goldhirsch, A;Coates, AS;Gelber, RD
目的：辅助细胞毒药物可延长可手术乳腺癌患者的无病生存期 (DFS) 和总生存期 (OS)。第一个报道的有效辅助联合方案包括第 1 至 14 天口服环磷酰胺，第 1 和 8 天静脉注射甲氨蝶呤和氟尿嘧啶，每 28 天重复一次（经典 CMF）。此后，这些药物在有或没有内分泌治疗和/或其他细胞毒性药物的情况下被广泛使用。尽管剂量和时间表差异很大，但这三种药物的组合通常称为 CMF。结果：减少 CMF 剂量和/或改变 CMF 时间表会损害其在转移性乳腺癌中的疗效。将类似方案的剂量减少到标准剂量以下，在辅助治疗中也产生较差的结果。结论：因此，剂量和时间表的细节可以部分解释 CMF 观察到的结果的异质性。特别有争议的是 CMF 对同时接受他莫昔芬 (TAM) 治疗的绝经后妇女的影响。然而，试验表明，即使在患有雌激素受体阳性肿瘤的绝经后女性中，在 TAM 中添加 CMF 也具有显着益处，这些试验使用的是经典 CMF。因此，当 CMF 用于辅助治疗时，建议遵循经典剂量和时间表。 (C) 1998 年美国临床肿瘤学会。
Purpose: Adjuvant cytotoxics prolong disease-free survival (DFS) and overall survival (OS) in patients with operable breast cancer. The first reported effective adjuvant combination regimen consisted of oral cyclophosphamide on days 1 to 14 with intravenous methotrexate and fluorouracil on days 1 and 8, repeated every 28 days (classical CMF). These drugs have since been extensively used with or without endocrine therapies and/or other cytotoxic agents. Although doses and schedules have varied widely, the combination of these three drugs is generically referred to as CMF.Results: Reducing the dose and/or altering the schedule of CMF have compromised its efficacy in metastatic breast cancer. Reduction below standard dose of a similar regimen also gave inferior results in the adjuvant setting.Conclusion: Details of dose and schedule may therefore explain part of the heterogeneity of results observed with CMF. Particular controversy surrounds the contribution of CMF in postmenopausal women who are also receiving tamoxifen (TAM). However, the trials that demonstrated a significant benefit for the addition of CMF to TAM, even in postmenopausal women with estrogen receptor-positive tumors, used classical CMF. Therefore, adherence to the classical dose and schedule is recommended when CMF is used in adjuvant therapy. (C) 1998 by American Society of Clinical Oncology.