Perry M C, Kardinal C G, Korzun A H, Ginsberg S J, Raich P C, Holland J F, Ellison R R, Kopel S, Schilling A, Aisner J
University of Missouri-Columbia.
J Clin Oncol. 1987 Oct;5(10):1534-45. doi: 10.1200/JCO.1987.5.10.1534.
In a prospective, randomized trial Cancer and Leukemia Group B (CALGB) evaluated CAF chemotherapy (cyclophosphamide + doxorubicin + 5-fluorouracil [5-FU]) v CAF plus tamoxifen (TCAF) in advanced breast cancer. Patients were stratified by estrogen receptor (ER) status, dominant site of metastatic disease, menopausal status, and prior adjuvant therapy. Regardless of ER status or menopausal status, the addition of tamoxifen conferred no significant advantage in response rate, response duration, time to treatment failure (TTF) or survival over CAF alone. A secondary objective was to compare the response to CAF of ER positive (ER+) and ER negative (ER-) patients to determine if there was a differential response to cytotoxic chemotherapy. Response rates of ER+ and ER- patients to CAF were identical (56%), but the response duration, time to treatment failure, and survival of ER+ patients were significantly longer than ER- patients. This lack of differential response implies that chemotherapy and hormonal therapy may compete for the same pool of ER+ cells. It also suggests that chemotherapy kills breast cancer cells indiscriminately, regardless of ER status.
在一项前瞻性随机试验中，癌症与白血病B组（CALGB）评估了CAF化疗方案（环磷酰胺+多柔比星+5-氟尿嘧啶[5-FU]）与CAF加他莫昔芬（TCAF）用于晚期乳腺癌的疗效。患者按雌激素受体（ER）状态、转移性疾病的主要部位、绝经状态和既往辅助治疗情况进行分层。无论ER状态或绝经状态如何，加用他莫昔芬在缓解率、缓解持续时间、治疗失败时间（TTF）或生存率方面相对于单纯CAF均无显著优势。第二个目标是比较ER阳性（ER+）和ER阴性（ER-）患者对CAF的反应，以确定对细胞毒性化疗是否存在差异反应。ER+和ER-患者对CAF的缓解率相同（56%），但ER+患者的缓解持续时间、治疗失败时间和生存率均显著长于ER-患者。这种缺乏差异反应表明化疗和激素治疗可能竞争同一组ER+细胞。这也表明化疗不分ER状态地 indiscriminately 杀死乳腺癌细胞。
