Treatment of metastatic breast cancer with adriamycin-cyclophosphamide induction followed by alternating combination therapy.

Thirty-four patients with metastatic breast cancer and no prior chemotherapy were treated with an induction regimen of four courses of adriamycin-cyclophosphamide followed by a fixed sequence of three courses of methotrexate-5-fluorouracil alternating with each course of adriamycin-cyclophosphamide. In this protocol, adriamycin can be administered for a minimum of 18 months before the dose of 550 mg/m2 is reached. The objective response rate was 56% (19 of 34 patients) with three complete responses and 16 partial responses. The median duration of response is 219 days and six of 19 patients remain in remission. The median survival of responders is 469 days while the nonresponders and progressors have a median survival of 273 days. The chemotherapy was administered in the outpatient department and was well tolerated. The scheduling of drugs in this study does not appear to result in significantly different response rates, duration of responses, or survival compared to those protocols in which these drugs are administered simultaneously.