Advanced breast cancer with bone-only metastases: a chemotherapeutically responsive pattern of metastases

Twenty-one patients, presenting with metastases only to bone from a primary adenocarcinoma of the breast having previously undergone mastectomy, tolerated aggressive cytotoxic chemotherapy (CAF--cyclophosphamide 500 mg/m2, Adriamycin 50 mg/m2, 5-fluorouracil 500 mg/m2 q 3 weeks) without significant clinical morbidity. Sixteen of the 21 achieved total clinical symptomatic improvement (pain, performance status). Eleven of these 16 patients tolerated and received between 75% and 100% of the original prescribed dose every 3 weeks, completing a total cumulative course dose of 450 mg/m2 of Adriamycin within 36 weeks, and remained clinically free of disease for an average of 26 months despite cessation of therapy. Their median survival is greater than 3 1/2 years. Those patients tolerating and receiving a dose of 50% or less developed early progression and had a relatively short survival. In general, patients with metastatic disease limited to bone have a relatively good prognosis and are tolerant of and benefit from aggressive cytotoxic therapy. In these patients an excellent clinical response can be achieved with a prolonged disease-free treatment-free period of life.