Randomized trial of cyclophosphamide, methotrexate, and fluorouracil chemotherapy added to tamoxifen as adjuvant therapy in postmenopausal women with node-positive estrogen and/or progesterone receptor-positive breast cancer: a report of the National Cancer Institute of Canada Clinical Trials Group. Breast Cancer Site Group. Journal Articles uri icon

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  • PURPOSE AND METHODS By the mid 1980s, tamoxifen alone was considered standard adjuvant therapy for postmenopausal women with node-positive, estrogen receptor (ER)- or progesterone receptor (PgR)-positive breast cancer. From 1984 through 1990, 705 eligible postmenopausal women with node-positive, ER- or PgR-positive breast cancer were randomized to a National Cancer Institute of Canada Clinical Trials Group (NCIC CTG) study that compared tamoxifen 30 mg by mouth daily for 2 years (TAM) versus TAM plus chemotherapy with all-intravenous cyclophosphamide 600 mg/m2, methotrexate 40 mg/m2, and fluorouracil 600 mg/m2 given every 21 days for eight cycles (CMF). RESULTS There were no significant differences in overall survival, recurrence-free survival, locoregional recurrence-free survival, or distant recurrence-free survival between the two treatment arms. However, there was significantly greater severe toxicity, which included leukopenia (P < .0001), nausea and vomiting (P < .0001), and thromboembolic events (P < .0001), as well as significantly more mild or greater toxicity, which included thrombocytopenia (P = .04), anemia (P = .02), infection (P = .0004), mucositis (P = .0001), diarrhea (P = .0001), and neurologic toxicity (P = .006), in women who received TAM plus CMF. CONCLUSION The addition of CMF to TAM adds no benefit and considerable toxicity in this group of women.


  • Pritchard, KI
  • Paterson, AH
  • Fine, S
  • Paul, NA
  • Zee, B
  • Shepherd, LE
  • Abu-Zahra, H
  • Ragaz, J
  • Knowling, M
  • Levine, Mark Norman
  • Verma, S
  • Perrault, D
  • Walde, PL
  • Bramwell, VH
  • Poljicak, M
  • Boyd, N
  • Warr, D
  • Norris, BD
  • Bowman, D
  • Armitage, GR
  • Weizel, H
  • Buckman, RA

publication date

  • June 1997