Neoadjuvant chemotherapy with cyclophosphamide, mitoxantrone, and 5-fluorouracil in locally advanced breast cancer

Objectives: Our primary objective was to determine the response rate; secondary objectives were to assess the toxicity rate, and disease- free and overall survival rates in patients with locally advanced breast cancer ( LABC) receiving a cyclophosphamide ( 500 mg/ m(2)), mitoxantrone ( 12 mg/ m(2)) and 5- fluorouracil ( 500 mg/m(2)) ( CMF) chemotherapy regimen. Patients and Methods: The data from 74 patients with LABC with neoadjuvant CMF chemotherapy were analyzed retrospectively. Preoperatively, all patients received 3 cycles of CMF on day 1, repeated every 21 days. In 3 ( 4.1%) patients, breast- conserving surgery was given and in 71 ( 95.9%) modified radical mastectomy. All patients received radiotherapy and 3 additional cycles of CMF chemotherapy after surgery. Results: Median age of the patients was 47 years ( range: 17 - 74). 43 patients were premenopausal, whereas 31 were postmenopausal. 54 patients were in stage IIIA, and 20 were in stage IIIB. The overall clinical response rate was 88%; 11 ( 14.9%) had a complete response, 54 ( 73%) had a partial response, and 2 ( 2.8%) had progression. 14 ( 18.9%) had a pathological complete response. The median follow- up was 62 months. The median disease- free survival was 64.9 months, and the median overall survival was 97.5 months. The 5- year disease- free and overall survival rates were 52% and 79.9%, respectively. Most frequent side- effects were nausea/ vomiting, mucositis, alopecia and leukopenia. Conclusion: The CMF regimen has a high overall response rate and an acceptable side-effect profile in the treatment of locally advanced breast cancer. Further studies are needed to evaluate its effectiveness in breast- conserving strategies.