Management of locally advanced and disseminated breast cancer--chemotherapy

Breast cancer is one of the most responsive of the common solid tumors when systemic therapy is indicated in the treatment of locally advanced or disseminated cancer. Many single agents have been useful in inducing remission in mammary carcinoma, but in recent years various drug combinations have been developed that appear more effective than individual drugs and in some instances with reduced toxicity levels. Adriamycin is the most interesting of the newer drugs and is the most effective single agent. Polychemotherapy of breast cancer was tried years ago, but remained for Cooper to arouse professional interest in multiple-drug therapy. Many modifications of this original five-drug regimens have been tried. One of the most widely used combinations is the CMF program, which includes cyclophosphamide, methotrexate, and 5-fluorouracil. The program that we have come to regard as our standard program in controlled clinical trials (CFP) employs cyclophosphamide, 5-fluorouracil, and prednisone. Toxicity with this program has been clinically acceptable, and in multiple comparative trials we have found no combination with greater therapeutic efficacy.