Cancer Treatment Today

The Breast International Group 02-98 randomized trial tested the effect of incorporating docetaxel into anthracycline-based adjuvant chemotherapy and compared sequential vs concurrent administration of doxorubicin and docetaxel. Two of the arms on this trial had AC followed by CMF.

Patients with lymph node-positive breast cancer (n = 2887) were randomly assigned to one of four treatments: 1) sequential control (four cycles of doxorubicin at 75 mg/m2, followed by three cycles of cyclophosphamide, methotrexate, and 5-fluorouracil [CMF]); 2) concurrent control (four cycles of doxorubicin at 60 mg/m2 plus cyclophosphamide at 600 mg/m2, followed by three cycles of CMF); 3) sequential docetaxel (three cycles of doxorubicin at 75 mg/m2, followed by three cycles of docetaxel at 100 mg/m2, followed by three cycles of CMF); 4) concurrent docetaxel (four cycles of doxorubicin at 50 mg/m2 plus docetaxel at 75 mg/m2, followed by three cycles of CMF). Note that only three cycles of CMF were administered in this trial. These two arms performed well. Docetaxel treatment resulted in an improvement in DFS of only borderline statistical significance compared with control treatment (HR = 0.86, 95% CI = 0.74 to 1.00; P = .05). DFS in the sequential docetaxel arm was better than that in the concurrent docetaxel arm (HR = 0.83, 95% CI = 0.69 to 1.00) and in the sequential control arm (HR = 0.79, 95% CI = 0.64 to 0.98).
AC followed by three cycels of CMG is Docetaxel treatment resulted in an improvement in DFS of borderline statistical significance compared with control treatment (HR = 0.86, 95% CI = 0.74 to 1.00; P = .05). However, DFS in the sequential docetaxel arm was better than that in the concurrent docetaxel arm (HR = 0.83, 95% CI = 0.69 to 1.00) and in the sequential control arm (HR = 0.79, 95% CI = 0.64 to 0.98). 1
AC followed by three (but not four) cycles of CMF is considered acceptable per peer-reviewed medical literature. Only three cycles should be approved.
CMF is returinng to respectability. A recent study suggested that it may be better than using antracyclines or taxanes in some subgroups of breast cancer 2.

1. Prudence Francis; John Crown; Angelo Di Leo; Marc Buyse; Ana Balil; Michael Andersson; Bo Nordenskjöld; Istvan Lang; Raimund Jakesz; Daniel Vorobiof; Jorge Gutiérrez; Guy van Hazel; Stella Dolci; Sophie Jamin; Belguendouz Bendahmane; Richard D. Gelber; Aron Goldhirsch; Monica Castiglione-Gertsch; Martine Piccart-Gebhart; On behalf of the BIG 02-98 Collaborative Group, Adjuvant Chemotherapy With Sequential or Concurrent Anthracycline and Docetaxel: Breast International Group 02-98 Randomized Trial. J Natl Cancer Inst. 2008;100(2):121-133.

2.Wang S1, Shi Y, Yuan Z, Wang X, Liu D, Peng R, Teng X, Qin T, Peng J, Lin G, Jiang X.Classical CMF regimen as adjuvant chemotherapy for triple-negative breast cancer may be more effective compared with anthracycline or taxane-based regimens.Med Oncol. 2012 Jun;29(2):547-53. .