Journal of Clinical Oncology, Vol 8, 1310-1320, Copyright © 1990 by American Society of Clinical Oncology
Chemotherapy versus tamoxifen versus chemotherapy plus tamoxifen in node-positive, estrogen receptor-positive breast cancer patients: results of a multicentric Italian study. Breast Cancer Adjuvant Chemo- Hormone Therapy Cooperative Group
F Boccardo, A Rubagotti, P Bruzzi, M Cappellini, G Isola, I Nenci, A Piffanelli, A Scanni, P Sismondi and L Santi
Istituto Nazionale per la Ricerca sul Cancro, Istituto di Oncologia dell Universita, Genova, Italy.
Between November 1, 1983 and June 30, 1987, 510 node-positive, estrogen
receptor (ER)-positive breast cancer patients have been randomly allocated
to receive either chemotherapy (six intravenous [IV] cyclophosphamide,
methotrexate, and fluorouracil [CMF] courses followed by four IV epirubicin
courses) or 5 years of tamoxifen treatment or a combination of both
therapies. After a median follow-up of 40 months, patients receiving the
combined treatment achieved the best results, and those treated with
chemotherapy alone achieved the worst, the difference being particularly
evident in postmenopausal women. However, while the concurrent use of
chemotherapy and tamoxifen did improve the results achieved by chemotherapy
alone, particularly in postmenopausal women and in those with four or more
involved nodes, it did not significantly improve the results achieved by
tamoxifen alone, particularly in patients with higher ER tumor
concentrations. Side effects were more numerous and more severe in patients
receiving chemotherapy (with or without tamoxifen). Our findings, although
still preliminary, confirm that tamoxifen should be the treatment of choice
for postmenopausal breast cancer patients with node-positive, ER- positive
tumors. In addition, the findings suggest that tamoxifen may represent a
safe alternative to chemotherapy (at least to the cytotoxic regimen we
used) for younger women, provided they have ER-positive tumors. In patients
with ER-positive tumors, the addition of chemotherapy to tamoxifen does not
seem to improve significantly the effectiveness of tamoxifen alone.
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