Adjuvant chemotherapy for breast cancer: 20 years experience using CVFMP chemotherapy

In late 1963, we embarked on a program that combined oral prednisone and oral cyclophosphamide (Cytoxan) with intravenous (IV) vincristine, fluorouracil, and methotrexate (CVFMP). The initial 60 patients had an 80% response. Since then, a multitude of different combinations and variations in drug dosage and timing have been used. Basically, patient responses have improved from single-agent remissions of 15% to 30%, which lasted only 3 to 4 months to remissions now achieved in as many as 80% of patients which last for more than 1 year. We initiated a pilot study of adjuvant CVFMP therapy in 100 women who had four or more positive nodes at original mastectomy. Chemotherapy alone was used in 73 patients, while 27 received radiotherapy and then chemotherapy. Chemotherapy consisted of oral doses of prednisone, 0.75 mg/kg/d, in three divided doses. This was reduced weekly by 50% and discontinued in the majority of patients. Cyclophosphamide, 2 mg/kg/d, was administered orally in two or three divided doses. Both methotrexate, 0.6 to 0.7 mg/kg, and 5-fluorouracil, 12 mg/kg, were administered IV once a week. Vincristine, at a dose of 25 micrograms/kg was administered IV once a week for 5 weeks or until significant neurologic defect was noted. Of the 73 patients who received only chemotherapy, 19 relapsed; 80% of those 73 patients were disease free at 14 years. Of the 27 patients who received radiotherapy before CVFMP, 23 relapsed; less than 10% were disease free at 13 years.