Long-Term
Follow-up Demonstrates Continued Superiority of CEF to CMF
in Breast Cancer
According to recent results presented at the 25th annual San
Antonio Breast Cancer Symposium, the anthracycline-based regimen
referred to as CEF demonstrates long-term superiority over
the chemotherapy regimen CMF in patients with early-stage
breast cancer, particularly those with 4 or more positive
lymph nodes.
Breast cancer is the second leading cause of cancer deaths
of women in the United States. Breast cancer that has not
spread to distant sites in the body, but may have spread to
local axillary (under the arm) lymph nodes, is considered
early stage. Following surgical removal of their cancer, patients
with early stage breast cancer are often offered chemotherapy
as an adjuvant therapy in order to kill any remaining cancer
cells that may have not been removed by surgery. Researchers
continue to compare different chemotherapy combinations as
adjuvant therapy for breast cancer, as new chemotherapy agents
emerge into the clinical setting. However, the results of
direct comparisons often take years to truly determine survival
benefits.
The chemotherapy combination consisting of cyclophosphamide,
methotrexate, and fluorouracil (CMF) was a commonly used adjuvant
therapy for the treatment of breast cancer; however, only
approximately 10% of oncology centers are currently utilizing
CMF. Chemotherapy agents known as anthracyclines (Ellence ®
(epirubicin) and doxorubicin (Adriamycin ®) have demonstrated
significant anti-cancer activity in breast cancer and researchers
initiated a clinical trial directly comparing CMF to CEF (cyclophosphamide,
Ellence ®, fluorouracil). This trial involved women who
were not postmenopausal and had early-stage breast cancer
with positive axillary nodes. Patients were randomly selected
to receive CMF or CEF. At 106 month follow-up, cancer was
15% less likely to recur following treatment with CEF compared
to CMF. In addition, overall estimated survival rates at 10
years following therapy were 62% for patients treated with
CEF, compared to 58% for those treated with CMF.
When subgroups were analyzed, the 10-year cancer-free survival
rate for women with just 1-3 positive axillary nodes was 60%
for patients treated with CEF, compared to 56% for patients
treated with CMF. However, the 10-year cancer-free survival
rate for women with 4 or more positive axillary nodes was
40% for patients treated with CEF, compared to 28% for patients
treated with CMF. Survival benefits of treatment with CEF
occurred in both estrogen receptor-positive and estrogen receptor-negative
breast cancer. Congestive heart failure (a condition that
often leads to heart failure and may be caused by anthracyclines)
occurred in 1.1% of patients treated with CEF, compared to
0.3% of patients treated with CMF. The rate of acute leukemias
occurred in 1.1% of patients treated with CEF, compared to
0.4% of patients treated with CMF.
These researchers concluded that long-term outcomes of treatment
with CEF appears superior to CMF as adjuvant therapy in early-stage,
lymph node-positive breast cancer, particularly in patients
with four or more positive nodes. Clinical trials are ongoing
to compare different chemotherapy regimens, including the
taxanes, as adjuvant therapy in breast cancer to determine
optimal regimens. In addition, researchers are evaluating
specific patient subgroups (i.e. patients who are HER2-positive
or have a specific genetic profile) and their responses to
different therapies. Patients with early-stage breast cancer
may wish to speak with their physician about the risks and
benefits of an anthracycline-based regimen or the participating
in a clinical trial further evaluating adjuvant therapies.
Two sources of information regarding ongoing clinical trials
include the National Cancer Institute ( www.cancer.gov) and
www.eCancerTrials.com. eCancerTrials.com also provides personalized
clinical trial searches on behalf of patients.
References:
1. Levine M, Bramwell V, Pritchard K, et al. Randomized trial
of intensive cyclophosphamide, epirubicin, and fluorouracil
chemotherapy compared with cyclophosphamide, methotrexate,
and fluorouracil in premenopausal women with node-positive
breast cancer. National Cancer Institute of Canada Clinical
Trials Group. Journal of Clinical Oncology. 1998;16:2651-2658.
2. Pritchard et al. Proceedings from the 25th annual San
Antonio Breast Cancer Symposium. San Antonio, Texas. December
11-14, 2002.
3. Laino C, Carlson R. CEF anthracyline-based regimen continues
demonstrated superiority to CMF. Oncology Times. Special Edition
coverage of the 25th San Antonio Breast Cancer Symposium.
February 2003.
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