Cyclophosphamide, Adriamycin, 5-Fluorouracil and High-dose Toremifene for Patients with Advanced/Recurrent Breast Cancer

Background: Multi-combination chemotherapy consisting of anthracyclines has been effective but has not invariably prolonged the survival period in advanced/recurrent breast cancer. The possibility hasbeendiscussed that chemoendocrine therapy combined with endocrine agents is more effective. Methods: In order to evaluate the toxicity and efficacy of a new endocrine therapy for advanced/recurrent breastcancer, we ran a pilot study during the period from July 1994to July 1996. Results: Twenty-two patients with advanced/recurrent breast cancer were treated with chemoendocrine therapy consisting of cyclophosphamide (100 mg/body) p.o. daily for 14 days, with adriamycin (40 mg/m 2) i.v. and 5-fluorouracil (500 mg/body) i.v, on day 1 (repeated every3 weeks for 9 weeks) (CAF therapy), and high-dose toremifene (120 mg/body) p.o. daily. Of 20 evaluable patients, two showed complete response (10 %), eight partial response (40%), six no change (30%) and four progressive disease (20%). The overall response ratewas 50%, and the median duration of response was 69.5 days (28-133+ days). The major toxicities were drug-induced alopecia, gastrointestinal toxicity andhematological toxicity, butthesewereclinically well tolerated. No serious cardiac, liver or renal symptom was seen. Conclusions: Based on these results, we consider the addition of high-dose toremifene to the CAFtherapy to be useful in the treatment of advanced and recurrent breast cancer.