A Retrospective Study of Adjuvant Chemotherapy with Adriamycin plus Cyclophosphamide, Methotrexate and 5-Fluorouracil for Postoperative Carcinoma of Breast: 6-Year Experience in a Single Institution

CKK Choi, RTT Chan, GKH Au, LCY Lui

Hong Kong J Radiol 2005;8:150-6

Objective: To determine the efficacy, toxicity and prognostic factors associated with adriamycin x 4 cycles plus cyclophosphamide, methotrexate and 5-fluorouracil x 6 cycles in the adjuvant treatment of high-risk breast cancer.

Patients and Methods: The records of patients who were offered adriamycin x 4 and cyclophosphamide, methotrexate and 5-fluorouracil x 6 or other anthracycline-based chemotherapy regimen at the Queen Mary Hospital between November 1996 and August 2003 were reviewed. The demographics, pathological data, details of chemotherapy, and data on relapse pattern, survival and treatment-related toxicity for those where this regimen was used as adjuvant therapy, were compiled and analysed.

Results: Forty patients treated with adriamycin x 4 and cyclophosphamide, methotrexate and 5-fluorouracil x 6 were included in the present analysis. Median age was 43 years (range, 30 to 69 years). The overall stage distribution was: stage I (0%), stage II (15%), stage III (85%), and stage IV (0%). All patients received 4 cycles of adriamycin and 96.0% received 6 cycles of cyclophosphamide, methotrexate and 5-fluorouracil. Radiotherapy and tamoxifen were given to 80% and 65% patients, respectively. At a median follow-up of 3.4 years, 9 patients relapsed, of whom 8 succumbed to their diseases and 1 patient remained alive. One patient died of an unrelated medical illness. Distant metastasis was the main cause of failure. The projected 5-year overall survival was 71.4% and 5-year disease-free survival was 69.7%. Most common side effects were nausea and vomiting.

Conclusions: Adjuvant chemotherapy with adriamycin x 4 plus cyclophosphamide, methotrexate and 5-fluorouracil x 6 for postoperative high-risk carcinoma of the breast demonstrated satisfactory efficacy in survival and good tolerability. It is likely that the failure to identify significant independent prognostic factors was a result of the small sample size.