Adjuvant chemotherapy for high-risk node-positive breast cancer: A tale of three generations

Abstract

Adjuvant chemotherapy for node-positive breast cancers has evolved a long way from the time-honoured non-anthracycline regimen of six cycles of CMF (cyclophosphamide, methotrexate, 5-fluorouracil) to the historical standard of anthracycline-based regimens of either four cycles of AC (adriamycin, cyclophosphamide) or six cycles of FAC/FEC (5-fluorouracil, adriamycinlepirubicin, cyclophosphamide), and now to the third-generation taxane-based regimens. Before the advent of taxanes, attempts to dose-escalate the anthracycline did improve outcome for the FEC regimen, but not the AC regimen. The Milan regimen, consisting of 12 cycles of sequential adriamycin followed by CMF, has also gained popularity in Europe especially for high-risk patients with a substantial number of metastatic nodes. For a few years, in Hong Kong public hospitals taxanes have become available to high-risk node-positive patients (lymph node number, > 3) at no extra costs. The published results of these taxane-based regimens in high-risk node-positive patients are reviewed. The results of a randomised phase 2 study for high-risk node-positive patients conducted in our institution before the taxane era, which compared the outcome and tolerance of the Milan regimen with the escalated FEC regimen (FE100C), are also briefly discussed with reference to the benefits of the current taxane-based chemotherapy. © 2011 Hong Kong College of Radiologists.