Adjuvant Chemotherapy Using Cyclophosphamide, Methotrexate, and Fluorouracil for Breast Cancer: the Tuen Mun Hospital Experience

KC Lee, CMM Lui, TY Ng, SH Lo, KK Yuen, FCS Wong, WK Sze, TW Leung, SY Tung, SK O

Hong Kong J Radiol 2004;7:14-23

Objective: This report is of the experience with combination cyclophosphamide, methotrexate, and fluorouracil as adjuvant treatment for breast cancer at Tuen Mun Hospital.

Patients and Methods: Records of patients who received combination cyclophosphamide, methotrexate, and fluorouracil chemotherapy during 1990 to 2000 were reviewed. Chemotherapy consisted of oral cyclophosphamide 100 mg/m2 on days 1 to 14, intravenous methotrexate 40 mg/m2 on days 1 and 8, and intravenous 5-fluorouracil 600 mg/m2 on days 1 and 8. Treatment was repeated every 4 weeks for 6 planned cycles.

Results: 406 patients were evaluable, of whom 352 (86.7%) completed 6 cycles of chemotherapy. The median duration of treatment was 24 weeks (range, 4 to 51 weeks). The median time from surgery to start of chemotherapy was 3.71 weeks (range, 1.3 to 36.7 weeks). Of the 406 patients, 34 (8.4%) were lost to follow up. At a median follow up of 4.75 years in June 2003, the status of the patients was as follows: 294 patients (72.4%) were alive and free of disease, 26 (6.4%) were alive with disease recurrence, while 83 (20.4%) died of breast cancer and 3 (0.7%) died of second malignancy. The 5- and 10-year relapse-free survival and overall survival were 72% and 64%, and 80% and 68%, respectively. The longest time interval between surgery and relapse was 9.41 years.

Conclusion: The use of the classical cyclophosphamide, methotrexate, and fluorouracil regimen as adjuvant chemotherapy for breast cancer patients in a community hospital has yielded early results comparable with those of the Milan Cancer Institute. With its favourable toxicity profile, cyclophosphamide, methotrexate, and fluorouracil could be offered to patients with early-stage breast cancer who cannot tolerate anthracycline-based chemotherapy due to other medical co-morbidities.