The University of Southampton
University of Southampton Institutional Repository

Epirubicin and cyclophosphamide, methotrexate, and fluorouracil as adjuvant therapy for early breast cancer

Epirubicin and cyclophosphamide, methotrexate, and fluorouracil as adjuvant therapy for early breast cancer
Epirubicin and cyclophosphamide, methotrexate, and fluorouracil as adjuvant therapy for early breast cancer
Background The National Epirubicin Adjuvant Trial (NEAT) and the BR9601 trial examined the efficacy of anthracyclines in the adjuvant treatment of early breast cancer.
Methods In NEAT, we compared four cycles of epirubicin followed by four cycles of cyclophosphamide, methotrexate, and fluorouracil (CMF) with six cycles of CMF alone. In the BR9601 trial, we compared four cycles of epirubicin followed by four cycles of CMF, with eight cycles of CMF alone every 3 weeks. The primary end points were relapse-free and overall survival. The secondary end points were adverse effects, dose intensity, and quality of life.
Results The two trials included 2391 women with early breast cancer; the median follow-up was 48 months. Relapse-free and overall survival rates were significantly higher in the epirubicin–CMF groups than in the CMF-alone groups (2-year relapse-free survival, 91% vs. 85%; 5-year relapse-free survival, 76% vs. 69%; 2-year overall survival, 95% vs. 92%; 5-year overall survival, 82% vs. 75%; P<0.001 by the log-rank test for all comparisons). Hazard ratios for relapse (or death without relapse) (0.69; 95% confidence interval [CI], 0.58 to 0.82; P<0.001) and death from any cause (0.67; 95% CI, 0.55 to 0.82; P<0.001) favored epirubicin plus CMF over CMF alone. Independent prognostic factors were nodal status, tumor grade, tumor size, and estrogen-receptor status (P<0.001 for all four factors) and the presence or absence of vascular or lymphatic invasion (P=0.01). These factors did not significantly interact with the effect of epirubicin plus CMF. The overall incidence of adverse effects was significantly higher with epirubicin plus CMF than with CMF alone but did not significantly affect the delivered-dose intensity or the quality of life.
Conclusions Epirubicin plus CMF is superior to CMF alone as adjuvant treatment for early breast cancer.
1851-1862
Poole, Christopher J.
82ac9543-b795-4643-b4c8-d51c524f9978
Earl, Helena M.
3f02904d-fe13-456c-822a-0ff4c6684834
Hiller, Louise
aeccce43-5212-4107-80be-ece7d860f7ca
Dunn, Janet A.
73ba3d7f-8148-4828-8b82-57f1399d9e2d
Bathers, Sarah
2b15af15-8928-40ae-b1d0-8b7ed159b0c3
Grieve, Robert J.
391decfc-cd79-403e-9aa2-f262f1869414
Spooner, David A.
d68a7bd2-d5e8-4702-9b87-11507b766782
Agrawal, Rajiv K.
63ae9ef2-9ed1-4a83-b07d-de785e0ce383
Fernando, Indrajit N.
516422a5-d494-44ed-a856-a3b8fe665e6b
Brunt, A. Murray
d480fe05-4c6b-453e-8f84-cef38ddca2fd
O'Reilly, Susan M.
f4bd494e-437f-4324-b408-677d55de1271
Crawford, S. Michael
c08c3547-e8c4-406e-ac1e-084879c5b6a9
Rea, Daniel W.
b5da7cac-6e00-49eb-95c6-33c5c38a5fe2
Simmonds, Peter
27d4c068-e352-4cbf-9899-771893788ade
Mansi, Janine L.
2f1b08eb-bf21-4083-901d-a34fe7e0ccb4
Stanley, Andrew
8a2e1207-00ad-4d81-bd9f-fd48c58bc1d1
Harvey, Peter
7acfdfd8-be98-4da6-a133-d4f7ba147487
McAdam, Karen
e1cdbf75-ad7f-4fb8-b227-9ed49fbf8a79
Foster, Liz
8eeec347-1a91-48f3-b727-de6b70f80c96
Leonard, Robert C.F.
7139b5ea-a1cf-4c41-b53e-01ab258bc4e5
Twelves, Christopher J., for the NEAT Investigators and the SCTBG
80dd6e1c-35ae-47dd-8cfc-3c3af8b42e14
Poole, Christopher J.
82ac9543-b795-4643-b4c8-d51c524f9978
Earl, Helena M.
3f02904d-fe13-456c-822a-0ff4c6684834
Hiller, Louise
aeccce43-5212-4107-80be-ece7d860f7ca
Dunn, Janet A.
73ba3d7f-8148-4828-8b82-57f1399d9e2d
Bathers, Sarah
2b15af15-8928-40ae-b1d0-8b7ed159b0c3
Grieve, Robert J.
391decfc-cd79-403e-9aa2-f262f1869414
Spooner, David A.
d68a7bd2-d5e8-4702-9b87-11507b766782
Agrawal, Rajiv K.
63ae9ef2-9ed1-4a83-b07d-de785e0ce383
Fernando, Indrajit N.
516422a5-d494-44ed-a856-a3b8fe665e6b
Brunt, A. Murray
d480fe05-4c6b-453e-8f84-cef38ddca2fd
O'Reilly, Susan M.
f4bd494e-437f-4324-b408-677d55de1271
Crawford, S. Michael
c08c3547-e8c4-406e-ac1e-084879c5b6a9
Rea, Daniel W.
b5da7cac-6e00-49eb-95c6-33c5c38a5fe2
Simmonds, Peter
27d4c068-e352-4cbf-9899-771893788ade
Mansi, Janine L.
2f1b08eb-bf21-4083-901d-a34fe7e0ccb4
Stanley, Andrew
8a2e1207-00ad-4d81-bd9f-fd48c58bc1d1
Harvey, Peter
7acfdfd8-be98-4da6-a133-d4f7ba147487
McAdam, Karen
e1cdbf75-ad7f-4fb8-b227-9ed49fbf8a79
Foster, Liz
8eeec347-1a91-48f3-b727-de6b70f80c96
Leonard, Robert C.F.
7139b5ea-a1cf-4c41-b53e-01ab258bc4e5
Twelves, Christopher J., for the NEAT Investigators and the SCTBG
80dd6e1c-35ae-47dd-8cfc-3c3af8b42e14

Poole, Christopher J., Earl, Helena M., Hiller, Louise, Dunn, Janet A., Bathers, Sarah, Grieve, Robert J., Spooner, David A., Agrawal, Rajiv K., Fernando, Indrajit N., Brunt, A. Murray, O'Reilly, Susan M., Crawford, S. Michael, Rea, Daniel W., Simmonds, Peter, Mansi, Janine L., Stanley, Andrew, Harvey, Peter, McAdam, Karen, Foster, Liz, Leonard, Robert C.F. and Twelves, Christopher J., for the NEAT Investigators and the SCTBG (2006) Epirubicin and cyclophosphamide, methotrexate, and fluorouracil as adjuvant therapy for early breast cancer. New England Journal of Medicine, 355 (18), 1851-1862. (doi:10.1056/NEJMoa052084).

Record type: Article

Abstract

Background The National Epirubicin Adjuvant Trial (NEAT) and the BR9601 trial examined the efficacy of anthracyclines in the adjuvant treatment of early breast cancer.
Methods In NEAT, we compared four cycles of epirubicin followed by four cycles of cyclophosphamide, methotrexate, and fluorouracil (CMF) with six cycles of CMF alone. In the BR9601 trial, we compared four cycles of epirubicin followed by four cycles of CMF, with eight cycles of CMF alone every 3 weeks. The primary end points were relapse-free and overall survival. The secondary end points were adverse effects, dose intensity, and quality of life.
Results The two trials included 2391 women with early breast cancer; the median follow-up was 48 months. Relapse-free and overall survival rates were significantly higher in the epirubicin–CMF groups than in the CMF-alone groups (2-year relapse-free survival, 91% vs. 85%; 5-year relapse-free survival, 76% vs. 69%; 2-year overall survival, 95% vs. 92%; 5-year overall survival, 82% vs. 75%; P<0.001 by the log-rank test for all comparisons). Hazard ratios for relapse (or death without relapse) (0.69; 95% confidence interval [CI], 0.58 to 0.82; P<0.001) and death from any cause (0.67; 95% CI, 0.55 to 0.82; P<0.001) favored epirubicin plus CMF over CMF alone. Independent prognostic factors were nodal status, tumor grade, tumor size, and estrogen-receptor status (P<0.001 for all four factors) and the presence or absence of vascular or lymphatic invasion (P=0.01). These factors did not significantly interact with the effect of epirubicin plus CMF. The overall incidence of adverse effects was significantly higher with epirubicin plus CMF than with CMF alone but did not significantly affect the delivered-dose intensity or the quality of life.
Conclusions Epirubicin plus CMF is superior to CMF alone as adjuvant treatment for early breast cancer.

Text
1851.pdf - Version of Record
Restricted to Repository staff only
Request a copy

More information

Published date: 2 November 2006

Identifiers

Local EPrints ID: 44624
URI: http://eprints.soton.ac.uk/id/eprint/44624
PURE UUID: c53d4717-863b-4a82-8c72-7720b8811cb2

Catalogue record

Date deposited: 02 Mar 2007
Last modified: 16 Dec 2019 19:19

Export record

Altmetrics

Contributors

Author: Christopher J. Poole
Author: Helena M. Earl
Author: Louise Hiller
Author: Janet A. Dunn
Author: Sarah Bathers
Author: Robert J. Grieve
Author: David A. Spooner
Author: Rajiv K. Agrawal
Author: Indrajit N. Fernando
Author: A. Murray Brunt
Author: Susan M. O'Reilly
Author: S. Michael Crawford
Author: Daniel W. Rea
Author: Peter Simmonds
Author: Janine L. Mansi
Author: Andrew Stanley
Author: Peter Harvey
Author: Karen McAdam
Author: Liz Foster
Author: Robert C.F. Leonard
Author: Christopher J., for the NEAT Investigators and the SCTBG Twelves

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×