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The combination of adjuvant chemotherapy consisting of 5-fluorouracil, doxorubicin and cyclophosphamide (FAC) appears superior to cyclophosphamide, methotrexate and 5-fluorouracil (CMF) in node-negative breast cancer patients, according to results presented at the 37th Annual Meeting of the American Society of Clinical Oncology.

Breast cancer is a common malignancy in women in the United States with an estimated 200,000 cases diagnosed annually. Analyses have confirmed the benefit of adjuvant therapy (treatment following surgery) over surgery alone for patients with early stage breast cancer. Clinical trials are ongoing in order to determine the most effective combination of chemotherapy agents in the adjuvant setting for patients with early stage breast cancer.

Recently, the Spanish Breast Cancer Research Group conducted a clinical trial directly comparing FAC to the established, standard chemotherapy treatment regimen of CMF in the adjuvant setting of early stage breast cancer patients. This study involved over 900 patients with stage I (cancer smaller than 2 centimeters with no spread) to stage IIIA (cancer smaller than 2 inches and spread to lymph nodes under the arms) breast cancer. Patient characteristics were equally distributed between patients receiving FAC or CMF.

At an average of 7 years following completion of therapy, approximately 87% of node-negative patients treated with FAC survived, compared with 78% of patients treated with CMF. Approximately 71% of node-negative patients who were treated with FAC experienced no cancer recurrence, compared with 62% who had received CMF. For node-positive patients in this study, there was no difference in survival or disease-free survival regardless of what treatment regimen they had received.

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These results are important because some physicians have been hesitant to administer chemotherapy containing an anthracycline compound (doxorubicin). This is because of potential side effects to the heart from doxorubicin. However, the results of this study suggest that the long-term survival benefits of FAC over CMF appears to warrant the use of doxorubicin instead of methotrexate in combination with 5-fluorouracil and cyclophosphamide for adjuvant treatment of women with node-negative breast cancer. Patients with early stage, node-negative breast cancer may wish to speak with their physician about the risks and benefits of receiving adjuvant FAC or participating in a clinical trial further evaluating adjuvant therapies. Two sources of information regarding ongoing clinical trials include comprehensive, easy-to-use listing services provided by the National Cancer Institute ( and also provides personalized clinical trial searches on behalf of patients. (37thAnnual Meeting of the American Society of Clinical Oncology, Abstract 126, San Francisco, CA, May, 2001)

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