Treatment of breast carcinoma recurrent after adjuvant chemoimmunotherapy.

Between July 1975 and June 1979, 194 patients with State II or III breast carcinoma were randomized to receive either L-phenylalanine mustard (L-PAM), cyclophosphamide and 5-fluorouracil and prednisolone (CFP), or CFP and BCG. Sixty-one patients have recurred despite the adjuvant chemoimmunotherapy trial. Fifty-three are evaluable for survival and 36 for response to chemo-hormonal therapy. Those treated with a chemo-hormonal regimen for their first recurrence exhibited a 53% objective response rate to cytotoxic therapy or a 35% response to hormonal therapy. Prior exposure to L-PAM, cyclophosphamide, or 5-fluorouracil did not preclude response to "salvage" therapy regimens containing those agents. Neither menopausal status, estrogen receptor content, size of the primary tumor, adjuvant treatment, nor extent of the recurrence had any effect on subsequent survival. Overall, the entire group exhibited median survival of 37 months from initial diagnosis and 13 months from recurrence. Unlike recurrent Hodgkin's disease, there was no demonstrable relationship between the length of the disease-free interval and the likelihood of subsequent response to cytotoxic or hormonal treatment. Comparison is made to the results of "salvage" therapy administered after three other large adjuvant treatment series.

Follow-up adjuvant chemotherapy and chemoimmunotherapy for stage II and III carcinoma of the breast.

Patients with stage II or III carcinoma of the breast were assigned to one of three adjuvant chemotherapy and chemoimmunotherapy treatment groups following radical or modified radical mastectomy. This study compares the efficacy of single drug treatment (melphalan) versus multiple drug regimens (CFP and CFP + BCG). In the initial phase of the project participants in the melphalan group showed a higher recurrence rate than those in the CFP and CFP + BCG groups. The recurrence rate of the melphalan group was 4.4 times higher than the recurrence rate of the combined polychemotherapy arms. However, after the initial phase, the recurrence rates for the polychemotherapy arms steadily increased and approached the dropping rate of the melphalan group. Currently (247 weeks after the beginning of the study and nine months after the last patient accrual), 194 patients have been treated (median follow-up time of 101 weeks), and no significant differences can be detected between the three treatment arms using any of the following criteria: disease-free interval, proportion of recurrence and recurrence rate. The only factors which are significant with respect to recurrence are the two prognostic factors: tumor size and degree of nodal involvement. The two chemotherapy groups, CFP and CFP + BCG, show no significant difference with respect to recurrence rate along the entire span of the study.