Combined Chemotherapy with Mitomycin C, Folinic Acid, and 5-Fluorouracil (MiFoFU) as Salvage Treatment for Patients with Liver Metastases from Breast Cancer – a Retrospective Analysis

Abstract

Background: The aim of this study was to analyze the activity and tolerability of a combined chemotherapy with mitomycin C, folinic acid, and 5-fluorouracil (MiFoFU) in patients with hepatic metastases from breast cancer, and in particular in patients with impaired liver function. Pa-tients and Methods: We retrospectively studied the charts of 44 patients who were treated with a MiFoFU combination therapy because of progressive metastatic breast cancer. Predominant site of metastases was the liver. Primary endpoints were response and time to progression (TTP); secondary endpoints were overall survival (OS) and tolerability. Results: Median age prior to treatment was 59 years. A median of 6 treatment cycles were administered per patient. Clinical benefit rate amounted to 64%. A mean TTP of 9 months and a mean OS of 14 months were found. Main clinical signs of nonhematological toxicity were stomatitis, nausea, and diarrhea. Grade III/IV hematotoxicity was seen in only 9 patients. 16 patients showed clinical signs of liver dysfunction. A clinical benefit could be achieved in 8 of these patients. Conclusions: MiFoFU combination chemotherapy is a well-tolerated treatment alternative in the palliative therapy of patients with liver metastases from breast cancer. Particularly in patients with hepatic dysfunction, this regimen seems to represent a helpful treatment option.

Mitomycin C in Patients with Gynecological Malignancies

“…The recurrence-free survival was4.5months,whichappearslowatfirstsight.Inviewofthe patientgroupinanadvancedpalliativetherapysituationwith clinically relevant hepatic metastases, however, these results can be regarded as good. Similar results for this group of patientswerealsopublishedbyEichbaumandGast [40]ina retrospectiveevaluationincluding44patients.Insteadofcalciumfolinate,asodiumfolinatecanbeusedtomodulatethe 5-FU.Thishastheadvantagethatthefolinicacidcanbeadministered together with 5-FU to optimize the treatment. Combinationtherapywith5-FU/sodiumfolinateandMMCis beinginvestigatedinaphaseI/IIstudythatiscurrentlystillin progress [38].…”

“…In the authors' view, the combination with 5-FU provides the greatest benefit at dosagesof2000mg/m 2 ,d1+d8+d15+d22+d29+d36,q50d, andMMC6-10mg/m 2 ,d1+d21 [38];and400mg/m 2 ,d1-d5, q21d, and MMC 3 mg/m 2 , d3-d5, q21d [22]. In cases of advancedhepaticmetastasiswithlimitedliverfunction,numeroustreatmentoptionscannolongerbecarriedout(e.g.with taxanes).MMCwith5-FUisaneffectiveandtolerableoption here [36,40].Thecombinationwithcapecitabinehasbeenan optionforseveralyears,allowingoraladministrationandwith comparable efficacy, and it is well supported by published data [35,37]. Another very recent area of application for MMC is in patients with triple-negative breast carcinoma.…”

Successful Remission of Extensive Liver Metastases in a Breast Cancer Patient with Acute Liver Failure Using a Combined Chemotherapy Regimen with Mitomycin, Folinate, and 5-Fluorouracil (Mi/Fo/FU)

“…patients with predominant liver metastases with a clinical benefit for the combined chemotherapy with Mi/Fo/FU at a rateof58%;similardataareshownon44patientswithaclini-calbenefitof64% [9].Abenefitofupto50%andamedian overallsurvivalof12.0monthsunderthetreatmentwithMi/ Fo/FU in patients with impaired hepatic function were reportedbyLoibletal. [7].Insummary,Mi/Fo/FUseemstobe awelltoleratedregimen.Inourcase,theMi/Fo/FUregimen was used as a salvage treatment for a breast cancer patient withhepaticfailure.Theaimsoftherapyinthepalliativesetting, such as relief of symptoms, improvement of quality of life,possibleprolongationofsurvival,andtherapyadministrationinanoutpatientsetting,couldsuccessfullybeachieved.…”