Primary chemotherapy in operable breast carcinoma comparing CMF (cyclophosphamide, methotrexate, 5-fluorouracil) with an anthracycline-containing regimen: Short-term responses translated into long-term outcomes

Giorgio Cocconi, B. Di Blasio, C. Boni, G. Bisagni, E. Rondini, M. A. Bella, F. Leonardi, L. Savoldi, C. Vallisneri, R. Camisa, P. Bruzzi

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Background: The role of anthracyclines has been extensively studied in adjuvant chemotherapy, but much less in the primary chemotherapy of early breast carcinoma. This study, comparing CMF (cyclophosphamide, methotrexate, 5-fluorouracil) with the rotational anthracycline-containing regimen CMFEV (CMF plus epirubicin and vincristine) administered as primary chemotherapy, demonstrated a significant increase in clinical complete response in premenopausal women. We report the long-term results. Patients and methods: Two hundred and eleven patients with stage I or II palpable breast carcinoma and a tumour diameter of >2.5 cm were randomised to receive CMF or CMFEV for four cycles before surgery. After surgery, the patients in both arms received adjuvant CMF for three cycles. Results: In the study population as a whole, there was a non-significant 20% reduction in mortality and relapse rates in the CMFEV arm. However, the effect of the experimental regimen was only found in premenopausal patients, especially in terms of relapse-free survival (P=0.07) and locoregional relapse-free survival (P=0.0009), thus mirroring the effect on response rates. After 10 years, the proportions of premenopausal patients free from locoregional relapse as a first event in the CMF and CMFEV groups were 68% and 97%, respectively. No relevant differences were found in postmenopausal patients. Conclusion: The overall results of this study showed that the greater activity of the experimental anthracycline-containing combination over CMF as primary chemotherapy in premenopausal patients translated into long-term effects in the same subgroup.

Original languageEnglish
Pages (from-to)1469-1476
Number of pages8
JournalAnnals of Oncology
Issue number9
Publication statusPublished - Sep 2005



  • Anthracycline
  • Breast carcinoma
  • CMF
  • Complete response
  • Outcome
  • Primary chemotherapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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