Anthracycline‑based induction chemotherapy followed by concurrent cyclophosphamide, methotrexate and 5‑fluorouracil and radiation therapy in surgically resected axillary node‑positive breast cancer

Abstract. The present study aimed to determine the toxicity and efficacy of 4 courses of anthracyclines‑taxane (AT) chemotherapy followed by radiation therapy (XRT) concurrent with cyclophosphamide, methotrexate and 5‑fluorouracil (CMF) in surgically resected axillary node‑positive (N+) breast cancer. A total of 200 women with N+ breast cancer were treated with adriamycin and docetaxel followed by XRT concurrent with six courses of CMF. Two courses of dose‑dense chemotherapy with ifosfamide, carboplatin and etoposide, supported by pegfilgrastim, were administered to patients with >5 histologically confirmed axillary lymph node metastases and patients with triple‑negative disease. Additional treatments included 1 year of trastuzumab in human epidermal growth factor receptor 2‑positive patients, 5 years of a luteinizing hormone‑releasing hormone analogue in premenopausal women and 5 years of an aromatase inhibitor (AI) in estrogen receptor‑positive (ER+) patients. The mean number of positive axillary lymph nodes was 4.4 (range, 2‑37), 52% of the patients were premenopausal, 74% were ER+ and 26% had triple‑negative disease. After a median follow‑up of 73 months, grade 2 and 3 hematological toxicity was observed in 20% of the patients. The 10‑year disease‑free survival (DFS) and overall survival (OS) rates were 73 and 77%, respectively. There was no significant difference in DFS between ER+ and estrogen receptor‑negative (ER‑) patients (P>0.05), whereas the OS was better in ER+ vs. ER‑ patients (P<0.05) and in premenopausal vs. postmenopausal patients (P<0.005). In conclusion, induction AT concurrent CMF and XRT and dose‑dense chemotherapy followed by AI in N+ high‑risk breast cancer was associated with a low level of systemic and late cardiac toxicity and excellent local control, DFS and OS.