An intensive sequenced adjuvant chemotherapy regimen for breast cancer.

Twenty-two women (17 pre- and 5 postmenopausal) with nodepositive, stage II breast carcinoma were treated with adjuvant chemotherapy consisting of 16 weeks of intensive CMFVP (cyclophosphamide, methotrexate, 5-fluorouracil, vincristine, and prednisone) administered in the original dose and schedule of the "Cooper regimen," followed by four monthly, 3-day cycles of escalating doxorubicin. Toxicity was related primarily to myelosuppression associated with the doxorubicin component of the treatment regimen. All patients recovered without sequelae. No patient developed significant cardiac toxicity. With a median follow-up of 43 months (range: 20-89 months), two postmenopausal patients and one premenopausal patient have relapsed at 35, 37, and 42 months, respectively. By Kaplan-Meier survival analysis, there is an 80.5% chance of disease-free survival to 42 months. The feasibility of administering adjuvant CMFVP followed by intensive doxorubicin has been established. The pilot results warrant comparative trial with the best of current regimens.