Forty-three consecutive patients with metastatic breast cancer and clearly measurable disease were treated with sequential multiagent chemotherapy. Therapy consisted of the administration in fixed sequence of cisplatin, doxorubicin, and cyclophosphamide (PAC) (four cycles), vinbbtine, doxorubicin, and dexamethasone (VAD) (six cycles), and VP-16, methotrexate, and 5-fluorouracil (VMF) (six cycles). At the conclusion of 16 cycles of chemotherapy, all treatment was stopped. Patients were assessed for toxicity and disease response after each treatment. Duration of response and survival rate were determined for 41 evaluable patients. The overall response rate was 80% with 24% complete responses, 15% to PAC alone. Median duration of response (8 months) and median survival (17 months) were not superior to other reported multiagent chemotherapeutic programs. Toxicity included neutropenic fever, sepsis, renal failure, and electrolyte imbalance. Administration of sequential multiagent chemotherapy with a cisplatincontaining combination did not improve response rate, complete responses (CR), duration of response, or survival in this group of previously untreated breast cancer patients.
Cancer 622105-2110,1988.
HE ADMINISTRATION OF MULTIAGENT CHEMO-
T THERAPY to patients with metastatic breast cancer results in tumor regression in 50% to 80% of those treated.' Complete responses (CR) occur in approximately 1 1 % to 20% of patients.'-3 The majority of patients, even those attaining CR, have progression of their disease leading to death.',' A variety of combinations of drugs and sequences of administration have been tried to improve tumor response and patient survival. In this report, the use of fixed sequential multiagent chemotherapy in metastatic breast cancer patients previously untreated with chemotherapy is described. The initial phase of treatment included cisplatin, doxorubicin, and cyclophosphamide (PAC), a combination reported to have high overall and CR rates in patients with advanced breast ~a n c e r . ~ It was hoped that rapid attainment of CR in a large proportion of patients would lead to improved survival and disease-free survival times.