A number of chemotherapy combinations have been used
in the treatment of breast cancer. But is there any regimen that may be better
than the rest? An analysis of more than 100 trials to compare the use of
different types of chemotherapy in early breast cancer was carried out. The
chemotherapy regimens studied were
• taxane-based versus non-taxane-based regimens
• anthracycline-based regimen versus standard or
near-standard cyclophosphamide, methotrexate, and fluorouracil (CMF) regimen
• higher versus lower anthracycline dosage
• polychemotherapy versus no adjuvant chemotherapy
The analysis found the following:
• The older
chemotherapy regimens reduced breast cancer deaths by about a quarter, the best being standard
CMF and standard 4AC regimens. With these regimens, 2-year recurrence rates
were halved and cancer recurrence rates during the next 8 years were reduced by
one-third. Regimens using lower doses per cycle were less effective.
• Regimens with substantially more chemotherapy than standard 4AC were more effective. These
included regimens such as CAF11, 15 or CEF19. These reduced deaths due to cancer by a further one-sixth.
• Chemotherapy reduced deaths due to cancer in all
groups over a period of 10 years by about a third as compared to no
chemotherapy. The reduction in deaths was irrespective of age, status of lymph
nodes, tumor diameter, tumor differentiation or presence of estrogen receptors
on the tumor.
• Deaths in ER-positive breast cancers are very much
reduced when chemotherapy is combined with endocrine treatment rather than
administration of endocrine treatment alone.
may thus be beneficial in a number of women with early breast cancer as
1. Comparisons between different polychemotherapy regimens for early
breast cancer: meta-analyses of long-term outcome among 100 000 women in 123
randomised trials; Breast cancer trials group; The Lancet, Volume 379, Issue
9814, Pages 432 - 444; Feb 2012.