Adjuvant Chemotherapy for High-risk Node-positive Breast Cancer: a Tale of Three Generations
RKC Ngan
Hong Kong J Radiol 2011;14(Suppl):S46-55
Adjuvant chemotherapy for node-positive breast cancers has evolved a long way from the time-honoured nonanthracycline regimen of six cycles of CMF (cyclophosphamide, methotrexate, 5-fluorouracil) to the historical standard of anthracycline-based regimens of either four cycles of AC (adriamycin, cyclophosphamide) or six cycles of FAC/FEC (5-fluorouracil, adriamycin/epirubicin, cyclophosphamide), and now to the third-generation taxane-based regimens. Before the advent of taxanes, attempts to dose-escalate the anthracycline did improve outcome for the FEC regimen, but not the AC regimen. The Milan regimen, consisting of 12 cycles of sequential adriamycin followed by CMF, has also gained popularity in Europe especially for high-risk patients with a substantial number of metastatic nodes. For a few years, in Hong Kong public hospitals taxanes have become available to high-risk node-positive patients (lymph node number, >3) at no extra costs. The published results of these taxane-based regimens in high-risk node-positive patients are reviewed. The results of a randomised phase 2 study for high-risk node-positive patients conducted in our institution before the taxane era, which compared the outcome and tolerance of the Milan regimen with the escalated FEC regimen (FE100C), are also briefly discussed with reference to the benefits of the current taxane-based chemotherapy.
中文摘要
淋巴結陽性乳癌的輔助化療：細說三代化學治療的故事
顏繼昌
高風險淋巴結陽性乳癌輔助化療的發展可以分為三代。從第一代不含蒽環類藥物（anthracycline）的 CMF（環磷酰胺cyclophosphamide、甲氨蝶呤methotrexate、5-氟尿嘧啶5-fluorouracil，6個療程)，到第 二代含有蒽環類藥物的歷史標準如AC（阿霉素adriamycin、環磷酰胺，4個療程) 或FAC/FEC（5-氟尿 嘧啶、阿霉素／表阿霉素epirubicin、環磷酰胺，6個療程)，發展至現在含有紫杉醇類（taxane）的第 三代化療。在未出現紫杉醇類藥物之前，曾有不同嘗試藉著提高蒽環類藥物劑量來改善療效，可惜 只有FEC方案可行，AC方案則未見改善。米蘭癌症研究所應用順序式阿霉素後再加上CMF共12個療 程，這聯合方案巳在歐洲普遍使用於那些高風險帶有大量淋巴結轉移的病人。香港公營醫院亦巳為 高風險淋巴結陽性乳癌患者（即淋巴結數目大於三）免費提供紫杉醇類療程達數年。本文回顧有關 高風險淋巴結陽性乳癌患者接受紫杉醇類療程後臨床結果的文獻。此外，本院在未發展紫杉醇類藥物化療之前，曾為高風險淋巴結陽性乳癌患者進行一項隨機（二期）研究，比較使用米蘭癌症研究 所的化療方案及另一個升級FEC方案（FE100C）的效果及耐受性。本文會根據現時紫杉醇類化療結 果作為參考，討論這項隨機研究的結果。