Four cases of cicatricial ectropion secondary to prolonged systemic administration of 5-fluorouracil are described. In 1 patient ectropion resolved with conservative treatment and discontinuation of 5-FU. Another patient developed the ectropion terminally and died before its resolution. In 2 patients surgical repair of the ectropion was unsuccessful in relieving conjunctival symptoms while 5-FU was continued. With prolonged adjuvant chemotherapy programs utilizing 5-FU, this complication may be seen with increasing frequency. Conservative management should be attempted, and patients with this problem should be reassured that symptoms will resolve when 5-FU is stopped.

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Seventy‐four women with advanced breast cancer were treated with a combination of continuous oral prednisone (45 mg/day × 2 wks, 30 mg/day × 2 wks, then 15 mg/day) and cyclophosphamide (100 mg/day), and weekly injections of 5‐fluorouracil, 500 mg; methotrexate, 25 mg; and vincristine, 1 mg. Thirtyone of 74 showed an objective response to therapy for a median length of 5 months. The responses were seen in soft tissue and visceral metastases. Definite recalcification of lytic bone lesions was seen in only 1 patient. Prior therapy decreased the number of responses to five‐drug therapy. With no prior cytotoxic therapy, 11/16 responded; with prior 5‐FU therapy 13/25 responded; with both prior 5‐FU and alkylating agent therapy, 7/33 responded. The median length of response was similar regardless of prior therapy. Toxicity was moderately severe; dosage modifications were necessary in the majority of patients, and there were seven drug contributory deaths during therapy. After failure of this combination, only 5/28 responded briefly to a variety of therapeutic measures. Comparable survival from first recurrence was seen whether response or failure occurred on five‐drug therapy. Trials of sequential vs. combination therapy will be necessary to define the role of combination therapy in advanced breast cancer.

Megestrol acetate is a potent oral progestin with anti‐estrogenic activity. It was given in doses of 40‐mg tablets after each meal and at bedtime (160 mg daily) to 30 patients with progressing disseminated breast cancer. It was well tolerated; no toxic reactions were observed. Seven patients < 23.3%) met the criteria of improvement as employed by the Cooperative Breast Cancer Group, and had a mean objective remission of 5.5 months. Most of the seven responders to megestrol acetate had prior trials with a sex hormone, and one or more cytotoxic compounds; three had a modified Cooper's five‐drug combination. The circumstance that this progestin has demonstrated utility late in the sequence of therapy bodes well for this compound having a useful role in the treatment of advanced breast cancer.

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