Hsieh C I, Liu M C, Cheng S H, Liu T W, Chen C M, Chen C M, Tsou M H, Huang A T
Department of Internal Medicine, National Health Research Institutes, Taipei, Taiwan.
Am J Clin Oncol. 2000 Apr;23(2):122-7. doi: 10.1097/00000421-200004000-00004.
Doxorubicin (Adriamycin) is an anthracycline effective in breast cancer. Despite a worldwide acceptance of Adriamycin in the adjuvant chemotherapy to maximize the survival benefit in the higher risk patients with breast cancer with promising results, oncologists in general do not favorably consider anthracyclines in the adjuvant treatment setting because of concern about the acute and chronic drug-related toxicity. For high-risk patients with breast cancer with more than three positive axillary lymph nodes, this series adopted a modified sequential regimen of ACMF first with Adriamycin (A) as a single agent in 3-weekly administration for three courses, and then a combination of cyclophosphamide, methotrexate, fluorouracil (CMF) every 3 to 4 weeks for six courses given in an outpatient setting concurrent with radiation therapy as an adjuvant treatment. A total of 56 patients underwent modified radical mastectomy and 3 others breast conservation surgery for their invasive breast cancer. Forty-seven (84%) patients completed the intended adjuvant treatment and 1 patient died of infection from treatment-related neutropenia. As a whole, the 3-year overall survival and disease-free survival rates of 56 patients analyzed were 82.3% and 64.4%, respectively. In this high-risk group, patients with four to nine positive nodes showed a slightly better trend of survival than those with 10 or more positive nodes without reaching statistically significant difference (36-month overall survival: 90.9% vs. 72.5%, p = 0.06; disease-free survival: 78.7% vs. 47.8%, p = 0.38). In this entire group of patients, locoregional recurrence was absent. A total of 55 episodes of grade III and IV hematologic toxicity were observed, with only one death from neutropenic sepsis. This modified ACMF regimen offers a good survival rate in breast cancer patients with more than three positive axillary lymph nodes. When these patients are carefully managed, the morbidity and mortality related to the treatment are low.
多柔比星（阿霉素）是一种对乳腺癌有效的蒽环类药物。尽管阿霉素在辅助化疗中已被全球认可，有望使高危乳腺癌患者的生存获益最大化且结果令人满意，但肿瘤学家一般不太倾向于在辅助治疗中使用蒽环类药物，因为担心其急性和慢性药物相关毒性。对于腋窝淋巴结转移超过3个的高危乳腺癌患者，本系列采用改良序贯ACMF方案，首先单独使用阿霉素（A），每3周给药1次，共3个疗程，然后每3至4周给予环磷酰胺、甲氨蝶呤、氟尿嘧啶联合方案（CMF），共6个疗程，在门诊进行，同时进行放射治疗作为辅助治疗。共有56例患者因浸润性乳腺癌接受了改良根治性乳房切除术，另外3例接受了保乳手术。47例（84%）患者完成了预定的辅助治疗，1例患者死于治疗相关中性粒细胞减少症引起的感染。总体而言，分析的56例患者的3年总生存率和无病生存率分别为82.3%和64.4%。在这个高危组中，腋窝淋巴结转移4至9个的患者的生存趋势略好于转移10个或更多的患者，但未达到统计学显著差异（36个月总生存率：90.9%对72.5%，p = 0.06；无病生存率：78.7%对47.8%，p = 0.38）。在整个患者组中，未出现局部区域复发。共观察到55例III级和IV级血液学毒性事件，仅有1例死于中性粒细胞减少性败血症。这种改良的ACMF方案为腋窝淋巴结转移超过3个的乳腺癌患者提供了良好的生存率。当对这些患者进行精心管理时，与治疗相关的发病率和死亡率较低。
