In 126 postmenopausal women with metastatic breast cancer, four chemotherapeutic combination programs were tested. Patients were stratified and randomized to one o f the four programs: (1) fluorouracil, cytoxan and prednisone (CFP): (2) fluorouracil, cytoxan and Adriamycin (CAF); (3) cytoxan and Adriamycin (CA); or (4) alternating combinations of CFP-CA. Objective response rates were 17% for 18 patients on CFP, 25% for 40 patients on CAF, 42% for 41 patients on CA and 63% for 19 patients on CFP-CA. CFP-CA provided a significantly higher response rate than either CFP or CAF. The response rate of CA was intermediate. The duration o f remission and survival were similar for all four groups. When progression or relapse following remission was demonstrated, patients were rerandomized to either adrenalectomy or tamoxifen. There were no responders either in the 15 patients undergoing adrenalectomy or the 11 patients receiving tamoxifen. In a crossover study, nine adrenalectomized patients received tamoxifen and four tamoxifen-treated patients underwent adrenalectomy. None responded. It appears that response rates to hormonal modalities are reduced in patients previously treated by combination chemotherapy. Cancer 49:1988Cancer 49: -1993Cancer 49: . 1982.
N STUDIES OF THE TREATMENT of metastatic breast I cancer',2 the combination of cytoxan, 5-fluorouracil
(5-FU) and prednisone (CFP) has proved to be effective. At the same time, two combination programs including Adriamycin (doxorubicin) were reported to produce a high yield of tumor response. The program of cytoxan and Adriamycin (CA) was effective in the experience of Jones and others3 and the program of cy-