Adding adjuvant CMF chemotherapy to either radiotherapy or tamoxifen: Are all CMFs alike?

A. Goldhirsch, M. Colleoni, A. S. Coates, M. Castiglione-Gertsch, R. D. Gelber

Research output: Contribution to journalArticlepeer-review


The first reported effective adjuvant combination regimen for patients with operable breast cancer comprised oral cyclophosphamide (C) days 1-14 with intravenous methotrexate (M) and fluorouracil (F) on days 1 and 8, repeated every 28 days ('classical' CMF). These drugs have since been extensively used with or without endocrine therapies and/or other cytotoxics, as well as with radiation therapy to the chest wall yielding conflicting results. Although doses and schedules have varied widely, the combination of these three drugs has been generically referred to as CMF. Evidence exists that reducing the dose and/or altering the schedule of CMF ('modified' CMF) have compromised its efficacy in metastatic breast cancer. Reduction below standard dose of a similar regimen also gave inferior results in the adjuvant setting. In fact, the recently reported improved outcome of adding radiation therapy to CMF was only demonstrated in comparisons with a 'modified' CMF. Furthermore, trials in women with estrogen receptor-positive breast cancer, which did not demonstrate any significant benefit for the addition of adjuvant CMF to tamoxifen compared with tamoxifen alone, also used 'modified' CMF. Therefore, adherence to the 'classical' dose and schedule is recommended when CMF is used in adjuvant therapy.

Original languageEnglish
Pages (from-to)489-493
Number of pages5
JournalAnnals of Oncology
Issue number5
Publication statusPublished - May 1998


  • Adjuvant chemotherapy
  • Breast cancer
  • CMF
  • Radiotherapy
  • Tamoxifen

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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