Classical Cyclophosphamide, Methotrexate, and Fluorouracil Chemotherapy is more effective in triple-negative, node-negative breast cancer: results from two randomized trials of adjuvant chemoendocrine therapy for node-negative breast cancer
Academic Article
Publication Date:
2010
Short description:
Classical Cyclophosphamide, Methotrexate, and Fluorouracil Chemotherapy is more effective in triple-negative, node-negative breast cancer: results from two randomized trials of adjuvant chemoendocrine therapy for node-negative breast cancer / Colleoni, M., Nolè, B.f., Viale, G., Regan, M.m., Price, K.n., Maiorano, E., Mastropasqua, M.g., Crivellari, D., Gelber, R.d., Goldhirsch, A., Coates, A.s., Gusterson, B.. - In: JOURNAL OF CLINICAL ONCOLOGY. - ISSN 0732-183X. - 28:(2010), pp. 2966-2973. [10.1200/JCO.2009.25.9549]
abstract:
Purpose
Retrospective studies suggest that primary breast cancers lacking estrogen receptor (ER) and
progesterone receptor (PR) and not overexpressing human epidermal growth factor receptor 2 (HER2;
triple-negative tumors) are particularly sensitive to DNA-damaging chemotherapy with alkylating
agents.
Patients and Methods
Patients enrolled in International Breast Cancer Study Group Trials VIII and IX with node-negative,
operable breast cancer and centrally assessed ER, PR, and HER2 were included (n 2,257). The
trials compared three or six courses of adjuvant classical cyclophosphamide, methotrexate, and
fluorouracil (CMF) with or without endocrine therapy versus endocrine therapy alone. We explored
patterns of recurrence by treatment according to three immunohistochemically defined tumor
subtypes: triple negative, HER2 positive and endocrine receptor absent, and endocrine receptor
present.
Results
Patients with triple-negative tumors (303 patients; 13%) were significantly more likely to have
tumors 2 cm and grade 3 compared with those in the HER2-positive, endocrine receptor–
absent, and endocrine receptor–present subtypes. No clear chemotherapy benefit was observed
in endocrine receptor–present disease (hazard ratio [HR], 0.90; 95% CI, 0.74 to 1.11). A statistically
significantly greater benefit for chemotherapy versus no chemotherapy was observed in triplenegative
breast cancer (HR, 0.46; 95% CI, 0.29 to 0.73; interaction P .009 v endocrine
receptor–present disease). The magnitude of the chemotherapy effect was lower in HER2-positive
endocrine receptor–absent disease (HR, 0.58; 95% CI, 0.29 to 1.17; interaction P .24 v
endocrine receptor–present disease).
Conclusion
The magnitude of benefit of CMF chemotherapy is largest in patients with triple-negative,
node-negative breast cancer.
Retrospective studies suggest that primary breast cancers lacking estrogen receptor (ER) and
progesterone receptor (PR) and not overexpressing human epidermal growth factor receptor 2 (HER2;
triple-negative tumors) are particularly sensitive to DNA-damaging chemotherapy with alkylating
agents.
Patients and Methods
Patients enrolled in International Breast Cancer Study Group Trials VIII and IX with node-negative,
operable breast cancer and centrally assessed ER, PR, and HER2 were included (n 2,257). The
trials compared three or six courses of adjuvant classical cyclophosphamide, methotrexate, and
fluorouracil (CMF) with or without endocrine therapy versus endocrine therapy alone. We explored
patterns of recurrence by treatment according to three immunohistochemically defined tumor
subtypes: triple negative, HER2 positive and endocrine receptor absent, and endocrine receptor
present.
Results
Patients with triple-negative tumors (303 patients; 13%) were significantly more likely to have
tumors 2 cm and grade 3 compared with those in the HER2-positive, endocrine receptor–
absent, and endocrine receptor–present subtypes. No clear chemotherapy benefit was observed
in endocrine receptor–present disease (hazard ratio [HR], 0.90; 95% CI, 0.74 to 1.11). A statistically
significantly greater benefit for chemotherapy versus no chemotherapy was observed in triplenegative
breast cancer (HR, 0.46; 95% CI, 0.29 to 0.73; interaction P .009 v endocrine
receptor–present disease). The magnitude of the chemotherapy effect was lower in HER2-positive
endocrine receptor–absent disease (HR, 0.58; 95% CI, 0.29 to 1.17; interaction P .24 v
endocrine receptor–present disease).
Conclusion
The magnitude of benefit of CMF chemotherapy is largest in patients with triple-negative,
node-negative breast cancer.
Iris type:
1.1 Articolo in rivista
Keywords:
Breast cancer; triple-negative breast cancer; node-negative breast cancer; chemotherapy; adjuvant chemotherapy
List of contributors:
Colleoni, M; Nolè, Bf; Viale, G; Regan, Mm; Price, Kn; Maiorano, Eugenio; Mastropasqua, Mg; Crivellari, D; Gelber, Rd; Goldhirsch, A; Coates, As; Gusterson, B.
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