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CEF Maintains Advantage Over CMF at 10 Years

CEF Maintains Advantage Over CMF at 10 Years

SAN ANTONIO—A 10-year update of Canada’s MA.5 trial has found a continuing
survival advantage for node-positive premenopausal breast cancer
patients treated with adjuvant cyclophosphamide/epirubicin (Ellence)/fluorouracil
(5-FU) (CEF) vs those given classic cyclophosphamide/methotrexate/5-FU (CMF).

Kathleen I. Pritchard, MD, head of Clinical Trials and Epidemiology at
Toronto-Sunnybrook Regional Cancer Centre, reported the 10-year results at
the 25th Annual San Antonio Breast Cancer Symposium (abstract 17).

710 Patients

The National Cancer Institute of Canada Clinical Trials Group MA.5 trial,
which began in 1989, involves 710 pre- or perimenopausal women with
early-stage breast cancer who had undergone radical mastectomy or lumpectomy
with axillary dissection and who had one or more positive nodes.

The patients were randomized to classic CMF (cyclophosphamide, 100 mg/m2
orally days 1 to 14; methotrexate, 40
mg/m2 IV days 1 and 8; and 5-FU, 600 mg/m2 IV days 1 and 8) or CEF (cyclophosphamide,
75 mg/m2 orally days 1 to 14; epirubicin, 60 mg/m2 IV days 1 and 8; and 5-FU,
500 mg/m2 IV days 1 and 8). The CEF arm included antibiotic prophylaxis with
daily cotrimoxazole. Both regimens were administered over six 4-week cycles.

Patients who had undergone lumpec-tomy received breast irradiation at the
completion of chemotherapy; locore-gional radiation was not permitted.
Tamoxifen (Nolvadex) was not part of the study protocol, Dr. Pritchard said,
and the vast majority of patients did not receive it.

Study Results


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