According to an article recently published in the New England Journal of Medicine, the addition of the anthracycline Ellence® (epirubicin) to the chemotherapy regimen known as CMF improves survival compared to CMF alone in the treatment of early breast cancer.
Early breast cancer refers to cancer that has not spread from the breast to distant sites in the body. Recently, great advancements in the treatment of early breast cancer have led to high cure rates for women with this disease. Treatment for early breast cancer typically consists of surgery, radiation therapy, chemotherapy, hormone therapy, and/or targeted therapy. Treatment following surgery is referred to as adjuvant therapy, and is used to kill any undetectable cancer cells that may remain in the body.
Adjuvant therapy for breast cancer typically includes an anthracycline, such as Ellence or Adriamycin® (doxorubicin). The chemotherapy combination CMF (cyclophosphamide, methotrexate, 5-fluorouracil) may also be used as adjuvant therapy for breast cancer; CMF was a standard chemotherapy regimen for this stage of disease. Currently, however, an anthracycline or a taxane (Taxotere® or Taxol®) is often used in combination with other chemotherapy agents for adjuvant therapy of breast cancer.
Researchers affiliated with the National Epirubicin Adjuvant Trial (NEAT) and the BR9601 trial evaluated the effectiveness of the addition of Ellence to CMF as adjuvant treatment of breast cancer to confirm that the current use of anthracyclines provides improved outcomes for these patients. These two trials included 2,391 women with early breast cancer who were treated with either Ellence plus CMF or CMF alone. Follow-up was approximately four years.
- At two years survival with no cancer recurrences was achieved in 91% of patients treated with the addition of Ellence, compared with 85% of patients treated with CMF only.
- At five years survival with no cancer recurrences was achieved in 76% of patients treated with Ellence/CMF, compared with 69% of patients treated with CMF only.
- Overall survival at two years was 95% for patients treated with Ellence/CMF and 92% for patients treated with CMF only.
- Overall survival at five years was 82% for patients treated with Ellence/CMF, and 75% for patients treated with CMF only.
- Side effects were greater among the group of patients treated with Ellence/CMF; however, side effects did not affect quality of life or the ability to safely administer treatment.
The researchers concluded that these results confirm that the addition of anthracyclines to CMF improves outcomes, including survival, when used as adjuvant treatment for early breast cancer. At present, it is standard practice to include anthracyclines in adjuvant therapy, unless patients are not able to tolerate these agents. In addition, women with early breast cancer may also receive hormone therapy, the addition of taxanes in their chemotherapy regimens, and/or targeted therapy as part of their adjuvant therapeutic regimens. Patients should discuss their individual risks and benefits of all treatment options with their physician.
Reference: Poole CJ, Earl HM, Hiller L, et al. Epirubicin and cyclophosphamide, methotrexate, and fluorouracil as adjuvant therapy for early breast cancer. New England Journal of Medicine. 2006;355:1851-1862.