© 1998 by Oxford University Press
Journal Of The National Cancer Institute, Vol 90, 1205-1211, Copyright © 1998 by Oxford University Press
DR Budman, DA Berry, CT Cirrincione, IC Henderson, WC Wood, RB Weiss, CR Ferree, HB Muss, MR Green, L Norton and E Frei 3rd
BACKGROUND: Both total dose and dose intensity of adjuvant chemotherapy are
postulated to be important variables in the outcome for patients with
operable breast cancer. The Cancer and Leukemia Group B study 8541 examined
the effects of adjuvant treatment using conventional-range dose and dose
intensity in female patients with stage II (axillary lymph node-positive)
breast cancer. METHODS: Within 6 weeks of surgery (radical mastectomy,
modified radical mastectomy, or lumpectomy), 1550 patients with unilateral
breast cancer were randomly assigned to one of three treatment arms: high-,
moderate-, or low-dose intensity. The patients received cyclophosphamide,
doxorubicin, and 5-fluorouracil on day 1 of each chemotherapy cycle, with
5-fluorouracil administration repeated on day 8. The high-dose arm had
twice the dose intensity and twice the drug dose as the low-dose arm. The
moderate-dose arm had two thirds the dose intensity as the high-dose arm
but the same total drug dose. Disease-free survival and overall survival
were primary end points of the study. RESULTS: At a median follow-up of 9
years, disease- free survival and overall survival for patients on the
moderate- and high-dose arms are superior to the corresponding survival
measures for patients on the low-dose arm (two-sided P<.0001 and
two-sided P = .004, respectively), with no difference in disease-free or
overall survival between the moderate- and the high-dose arms. At 5 years,
overall survival (average +/- standard error) is 79% +/- 2% for patients on
the high-dose arm, 77% +/- 2% for the patients on the moderate-dose arm,
and 72% +/- 2% for patients on the low-dose arm; disease-free survival is
66% +/- 2%, 61% +/- 2%, and 56% +/- 2%, respectively. CONCLUSION: Within
the conventional dose range for this chemotherapy regimen, a higher dose is
associated with better disease-free survival and overall survival.
ARTICLES
Dose and dose intensity as determinants of outcome in the adjuvant treatment of breast cancer. The Cancer and Leukemia Group B
Department of Medicine, North Shore University Hospital-New York University School of Medicine, Manhasset 11030, USA. budman@nshs.edu
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