Chemotherapy of advanced breast cancer: a controlled randomized trial of cyclophosphamide versus a four-drug combination

Abstract

Summary.-Ninety-nine patients with advanced breast cancer were randomized to receive either cyclophosphamide continuously or a combination of cyclophosphamide, methotrexate, 5 -fluorouracil and vinblastine given intermittently. The number and duration of objective responses were greater in patients receiving the combination but the differences between the two treatments did not achieve formal significance. The combination was logistically easier to manage and produced less toxicity.

First-Line Monochemotherapy with Mitoxantroneversus Combination with Fluorouracil, Epirubicin and Cyclophosphamide in High-Risk Metastatic Breast Cancer: A Prospective Randomized Multicenter Clinical Trial

“…monotherapy. Thus, the outcome of this prospective randomized trial confirm the results found in retrospective analyses by Smalley [7], Hoogstraten [8], Rubens [9] and Ahmann [10]. However, Carmo-Pereira [11] using fluorouracil, Canellos [12] using phenylalanin mustard, and Mouridsen [13] using cyclophosphamide as monotherapy got better OAS in the combination treatment.…”

Combination versus sequential single agent chemotherapy in advanced breast cancer: associations with metastatic sites and long-term survival

“…Single agent chemotherapy has been compared to 13 combination chemotherapy regimens in randomised trials of patients with advanced breast cancer (Ahman et al, 1974(Ahman et al, , 1987Baker et al, 1974;Canellos et al, 1976;Chlebowski et al, 1979;Hoogstraten et al, 1976;Lemkin & Dollinger, 1973;Mouridsen et al, 1976;Nemoto et al, 1978;Rubens et al, 1975;Smalley et al, 1976). Despite the fact that combination chemotherapy resulted in significantly higher objective response frequency and complete response frequency in six of these trials with duration of response significantly higher in seven of these trials, no increase in overall survival was associated with combination compared to single agent chemotherapy in any trial.…”

Impact of Initial Therapy on Survival in Recurrent Breast Cancer

“…Powles et al [9] reported that they had not seen any improvement in overall survival by modern chemo therapy for patients with primary breast cancer, nor a prolongation of survival from first metastasis. In fact, since the introduction of multiple-drug chemotherapy, they considered that survival from first metastasis seemed to have shortened [9], Other authors also claimed that even if modern combination chemo therapy achieved excellent response rates for recurrent breast cancer, most combination chemoterapies did not appear to have improved overall survival [4,5,8], On the other hand, some investigators reported that survival from first metastasis was improved by modern combination chemotherapy [10,11]. It is dif ficult to explain these differences of survival results.…”

“…Various reports have indicated that multiple drug chemotherapy con taining ADR has a good response rate of 50-70% in patients with advanced or recurrent breast cancer [1][2][3], and that responders survive longer than nonre sponders. Despite the increased use of more aggres sive combination chemotherapy for the first-line treat ment after recurrence, it still remains controversial whether aggressive chemotherapies produce any ad vantages in survival compared with less aggressive approaches, such as additive endocrine therapy or sequential single-agent chemotherapy [4][5][6][7][8]. An im provement in the chemotherapy response rate does not always correlate with an improvement in survival after recurrence.…”