COMMON QUESTIONS ABOUT BREAST CANCER: WHICH DRUGS ARE GIVEN IN COMBINATION CHEMOTHERAPY?
One of the most commonly used drug combinations in breast cancer is the CMF regimen that uses cyclophosphamide, methotrexate, and 5-fluorouracil. Many oncologists consider this the standard treatment for breast cancer that has metastasized to the lymph nodes. For patients requiring less aggressive therapy, the cyclophosphamide may be eliminated. For patients needing slightly more aggressive therapy, adriamycin may be given instead of methotrexate. Because adriamycin is more potent and has more side effects than methotrexate, it is reserved for more aggressive therapies. Regimens using adriamycin may also include cyclophosphamide and 5-fluorouracil; they are then known as CAF or FAC.
Vincristine and prednisone may be added to CMF if still more aggressive therapy is required. For patients with advanced disease, a combination of cyclophosphamide, adriamycin, and vincristine (CAV) or of vinblastine, adriamycin, thiotepa, and the hormonal agent halotestin (VATH) may be administered.
Alternating treatment programs, such as CMF combined with VATH, or high-dose regimens may also be given. As yet, few studies have evaluated the order of drugs given in alternating regimens; however, it appears likely that the sequence may make a difference. In one study by Bonadonna and colleagues an improvement in disease-free survival (the length of time the patient is free of disease from diagnosis until tumor recurrence) and in overall survival (the length of time the patient survives following diagnosis) was noted in patients receiving adriamycin followed by cyclophosphamide, methotrexate, and 5-fluorouracil.