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Prospective randomized study of cyclophosphamide, epirubicin, and 5-fluorouracil versus cyclophosphamide, adriamycin, and 5-fluorouracil in advanced or recurrent breast cancer

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Abstract

Background

Treatment with cyclophosphamide, adriamycin, and 5-fluorouracil (CAF), a widely used, potent regimen is sometimes restricted by the myelotoxicity and myocardiotoxicity of adriamycin (ADR). In a prospective randomized controlled study of patients with advanced or recurrent breast cancer, the efficacy and toxicity of a CEF regimen, in which epirubicin (EPI) was substituted for ADR, was compared with CAF.

Methods

138 female patients under 75 years of age who had unresectable or recurrent breast cancer during the period from October, 1989 to September, 1991, were randomized to one of two treatment regimens. The first regimen consisted of cyclophosphamide 100 mg p.o. d1-14, adriamycin 30 mg/mp2 i.v. d1, 8 and 5-fluorouracil 500 mg/mp2 i.v. d1, 8 (CAF). In the second regimen, EPI 30 mg/mp2 i.v. d1, 8 was substituted for ADR (CEF). Both regimens were delivered q4 weeks.

Results

Of 138 patients, 105 (CEF 56, CAF 49) were evaluable for response and survival, and all were evaluable for toxicity (CEF 68, CAF 70). The median course of lots CEF and CAF was 3 cycles. Response rates (complete response plus partial response) with CEF and CAF were 35.7% (20/56) and 36.7% (1 8/49), respectively. Adverse effects were similar in the two groups, but severe leukopenia (CEF 36.8%, CAF 64.3%) and hepatic toxicity (CEF 1.5%, CAF 12.9%) were encountered more frequently with CAF than with CEF. The duration of 50% survival was 135.9 weeks for CEF and 172.1 weeks for CAF (not significant).

Conclusion

At an equal dose of EPI and ADR response rates and survival of the CEF group were similar to those of the CAF group, but adverse effects were fewer in the CEF group.

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Abbreviations

ADR:

Adriamycin

CAF:

Cyclophosphamide, adriamycin, and 5-fluorouracil

CEF:

Cyclophosphamide, epirubicin, and 5-fluorouracil

CR:

Complete response

EPI:

Epirubicin

ER:

Estrogen receptor

PD:

Progressive disease

PR:

Partial response

PR:

Progesterone receptor

WBC:

White blood cell

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Authors and Affiliations

  1. Osaka National Hospital, Japan

    Tetsuro Kobayashi

  2. Osaka Medical Center for Cancer Cardiovascular Diseases, Japan

    Hiroki Koyama & Takaichiro Suzuki

  3. Kyoto Prefectural University of Medicine, Japan

    Takahiro Oka & Tadaki Yasumura

  4. Rakuyo Hospital, Japan

    Norimichi Kan

  5. Kansai Rosai Hospital, Japan

    Yuichi Takatsuka

  6. School of Medicine, Kanazawa University Hospital, Japan

    Masakuni Noguchi

  7. Osaka City University Medical School, Japan

    Ken Morimoto

  8. Hamamatsu Rosai Hospital, Japan

    Takayoshi Tobe

  9. Kaizuka Municipal Hospital, Japan

    Takesada Mori

Authors
  1. Tetsuro Kobayashi
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  2. Hiroki Koyama
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  3. Takahiro Oka
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  4. Tadaki Yasumura
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  5. Norimichi Kan
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  6. Yuichi Takatsuka
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  7. Masakuni Noguchi
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  8. Ken Morimoto
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  9. Takaichiro Suzuki
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  10. Takayoshi Tobe
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  11. Takesada Mori
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Kobayashi, T., Koyama, H., Oka, T. et al. Prospective randomized study of cyclophosphamide, epirubicin, and 5-fluorouracil versus cyclophosphamide, adriamycin, and 5-fluorouracil in advanced or recurrent breast cancer. Breast Cancer 6, 37–42 (1999). https://doi.org/10.1007/BF02966904

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  • DOI: https://doi.org/10.1007/BF02966904

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