Adjuvant Chemotherapy of Early Stage Breast Cancer in Community-based Cancer Treatment Fields: CMF Compared with Anthracycline/Taxane-based Regimens

Introduction: Mortality rate of breast cancer has been fallen in recent years. Combination of cyclophosphamide, methotrexate, and ۵-fluorouracil(CMF), as a pioneer of adjuvant chemotherapy of breast cancer, and later introduced anthracycline/taxane(A/T)-based regimens have both produced favorable outcomes in early-stage breast cancer. The current study, aimed to evaluate the probably different outcomes between CMF and A/T regimens.Methods: In this cohort study, we extracted medical records of ۱۰۹۸ breast cancer patients referred to some oncology centers of Mashhad University of Medical Sciences from ۱۳۷۰ to ۱۳۹۰. Invasive cancers on stages I and II candidate for systemic chemotherapy were included. We categorized patients in the CMF and A/T arms and considered median event free survival (EFS), median overall survival (OS), ۵- and ۱۰-year EFS, and ۵- and ۱۰-year OS as the endpoints of the study.Results: In the CMF arm, median EFS was ۱۹۰ months and the ۵ and ۱۰-year EFS were ۷۷% and ۶۱% respectively, while in the A/T arm, median EFS was ۲۱۲ months and ۵ and ۱۰-year EFS were ۷۴% and <۶۱% respectively, without significant difference between two arms (P= ۰.۳). The ۵ and ۱۰-year OS were ۸۷% and ۷۶% in the CMF arm respectively, and ۸۳% and <۷۶% in the A/T arm respectively (p=۰.۲).Stage and estrogen receptor (ER) status significantly affected outcome in univariate analysis, however, the only important prognostic factor in multivariate analysis was the disease stage.Conclusion: Similar effectiveness exists between CMF and A/T-based regimens regarding outcomes of adjuvant treatment for early-stage breast cancer. We could be confident that CMF is more favorable due to infrequent side effects.