Concurrent cyclophosphamide, methotrexate, and 5‐fluorouracil chemotherapy and radiotherapy for breast carcinoma

Abstract

BACKGROUND The current study was conducted to assess the toxicity of concurrent adjuvant cyclophosphamide, methotrexate, and 5‐fluorouracil (CMF) chemotherapy and radiotherapy (RT) for early breast carcinoma. METHODS In the current study, the authors reviewed the records of 680 consecutive breast carcinoma patients who received adjuvant CMF at the Princess Margaret Hospital between 1980–1990. Surgery was comprised of mastectomy in 64% of patients, breast conservation in 35% of patients, and was unknown in 1% of patients. Two hundred two patients received concurrent CMF/RT that was defined as an overlap in CMF and RT administration of at least 21 days. Forty‐seven patients received sequential CMF/RT (defined as no overlap or an overlap of < 7 days in CMF and RT administration). Other patients received CMF alone. Adverse effects of RT were graded retrospectively using the Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) system. Reasons for interruption or failure to complete RT were recorded. The magnitude of chemotherapy dose reductions and delays also were noted. RESULTS The median age of the patients was 44 years (range, 26–68 years) and 88% of the patients had lymph node‐positive disease. RT was interrupted or discontinued due to side effects in 4% of patients (95% confidence interval [95% CI], 1.7–7.7%) and 0% (95% CI, 0–7.6%), respectively, of the concurrent and sequential groups (P = 0.36). The incidence of Grade 3 or Grade 4 RT toxicity was 1.5% (95% CI, 0.3–4.3%) and 2.1% (95% CI, 0.1–11.3%), respectively, for the concurrent and sequential groups (P = 0.57). The median relative dose intensity of chemotherapy for patients receiving concurrent CMF/RT, sequential CMF/RT, and CMF alone was 0.87, 0.84, and 0.85, respectively (P = 0.22). CONCLUSIONS The results of the current study demonstrate that the concurrent administration of CMF and RT is associated with a low risk of serious toxicity and is an acceptable adjuvant regimen for patients with breast carcinoma. Cancer 2002;95:696–703. © 2002 American Cancer Society. DOI 10.1002/cncr.10744

Feasibility of concurrent adjuvant chemotherapy and radiotherapy after breast‐conserving surgery in early breast cancer

“…These conflicting results might be influenced by different CT regimens. In a study comparing concurrent CMF CT with RT to CMF alone and/or sequential groups, there was no difference in adverse effects according to relative dose intensity of CT [18]. Our study also indicates no increase in hematologic and RT-related toxicities with concurrent CT and RT.…”

Arsenic trioxide prevents radiation-enhanced tumor invasiveness and inhibits matrix metalloproteinase-9 through downregulation of nuclear factor κB

“…Integrating chemotherapeutic agents and radiotherapy has been found to improve overall survival rates for over a dozen human cancers, including lung, breast, head and neck, and cervical cancer (Choy et al, 1998;Rose et al, 1999;Isaac et al, 2002;Forastiere et al, 2003). The emerging rationale for combining radiation and chemotherapy includes improving locoregional tumor control and coping with systemic micrometastasis (Choy and Kim, 2003).…”

Synthesis of texaphyrin conjugates

“…They rely on the use of methotrexate, 25, rather than cis-Pt, as the active chemotherapeutic group. Methotrexate is a cell cycle inhibitor that has a well-recognized role in oncology and is an agent that is used widely in conjunction with other cancer drugs [41][42][43]. Thus, potentiation of methotrexate by MGd might be anticipated, and has indeed been reported in in vitro models [44].…”