A randomized study of paclitaxel versus cyclophosphamide/methotrexate/- fluorouracil/prednisone in previously untreated patients with advanced breast cancer: Preliminary results

J. F. Bishop, J. Dewar, G. Toner, M. H. Tattersall, I. Olver, S. Ackland, I. Kennedy, D. Goldstein, H. Gurney, E. Walpole, J. Levi, J. Stephenson

Research output: Contribution to journalArticleResearchpeer-review

Abstract

When administered as a single agent to previously treated patients with advanced breast cancer, paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) has good activity. This trial was undertaken to compare paclitaxel with standard chemotherapy as front-line treatment for this disease. Patients with measurable or evaluable metastatic breast cancer, no prior chemotherapy for metastatic disease, and Eastern Cooperative Oncology Group performance status of 0 to 2 were randomized to receive either paclitaxel 200 mg/m2 intravenously over 3 hours for eight cycles over 24 weeks or standard treatment with oral cyclophosphamide 100 mg/m2/d days 1 to 14, intravenous methotrexate 40 mg/m2 days 1 and 8, intravenous 5- fluorouracil 600 mg/m2 days 1 and 8, and oral prednisone 40 mg/m2 daily days 1 to 14 (CMFP) for six cycles over 24 weeks. Patients whose disease progressed or relapsed were recommended for second-line therapy with epirubicin. Accrual has been completed with 209 patients randomized, and an interim analysis of the first 100 patients is reported here. Analysis of quality of life, assessed by the linear analogue scale and overall quality of life indices, is ongoing. Objective response occurred in 31% (confidence interval, 19% to 45%) with paclitaxel and 35% (confidence interval, 22% to 51%) with CMFP, with stable disease in an additional 33% and 29%, respectively. Median time to progression was 5.5 months with paclitaxel and 6.4 months with CMFP, with a median survival of 17.3 months for patients treated with paclitaxel and 11.3 months for those given CMFP. Grades 3 and 4 neutropenia occurred in 64% of patients with paclitaxel and 63% with CMFP. However, febrile neutropenia was the primary reason for hospitalization in 1% of paclitaxel courses, compared with 8% with CMFP. Major infections (World Health Organization grade 4) were seen in 7% of patients treated with CMFP, but in none of those given paclitaxel. Moderate or severe mucositis occurred in 13% of paclitaxel and 27% of CMFP patients. Alopecia and peripheral neuropathy were more common with paclitaxel. Quality of life assessments in the first 100 patients suggest better overall results for those treated with paclitaxel compared with CMFP. Preliminary analyses suggest that single- agent paclitaxel is well tolerated and provides control of metastatic cancer comparable to that of CMFP combination therapy when used as front-line therapy in an outpatient setting.

LanguageEnglish
PagesS17-5-S17-9
Number of pages5
JournalSeminars in Oncology
Volume24
Issue number5 SUPPL. 17
Publication statusPublished - 1997
Externally publishedYes

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Prednisone
Paclitaxel
Methotrexate
Fluorouracil
Cyclophosphamide
Breast Neoplasms
Quality of Life
Confidence Intervals
Therapeutics
Drug Therapy
Febrile Neutropenia
Epirubicin
Mucositis
Alopecia
Peripheral Nervous System Diseases
Neutropenia
Hospitalization
Outpatients

Cite this

Bishop, J. F., Dewar, J., Toner, G., Tattersall, M. H., Olver, I., Ackland, S., ... Stephenson, J. (1997). A randomized study of paclitaxel versus cyclophosphamide/methotrexate/- fluorouracil/prednisone in previously untreated patients with advanced breast cancer: Preliminary results. Seminars in Oncology, 24(5 SUPPL. 17), S17-5-S17-9.
Bishop, J. F. ; Dewar, J. ; Toner, G. ; Tattersall, M. H. ; Olver, I. ; Ackland, S. ; Kennedy, I. ; Goldstein, D. ; Gurney, H. ; Walpole, E. ; Levi, J. ; Stephenson, J. / A randomized study of paclitaxel versus cyclophosphamide/methotrexate/- fluorouracil/prednisone in previously untreated patients with advanced breast cancer : Preliminary results. In: Seminars in Oncology. 1997 ; Vol. 24, No. 5 SUPPL. 17. pp. S17-5-S17-9.
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abstract = "When administered as a single agent to previously treated patients with advanced breast cancer, paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) has good activity. This trial was undertaken to compare paclitaxel with standard chemotherapy as front-line treatment for this disease. Patients with measurable or evaluable metastatic breast cancer, no prior chemotherapy for metastatic disease, and Eastern Cooperative Oncology Group performance status of 0 to 2 were randomized to receive either paclitaxel 200 mg/m2 intravenously over 3 hours for eight cycles over 24 weeks or standard treatment with oral cyclophosphamide 100 mg/m2/d days 1 to 14, intravenous methotrexate 40 mg/m2 days 1 and 8, intravenous 5- fluorouracil 600 mg/m2 days 1 and 8, and oral prednisone 40 mg/m2 daily days 1 to 14 (CMFP) for six cycles over 24 weeks. Patients whose disease progressed or relapsed were recommended for second-line therapy with epirubicin. Accrual has been completed with 209 patients randomized, and an interim analysis of the first 100 patients is reported here. Analysis of quality of life, assessed by the linear analogue scale and overall quality of life indices, is ongoing. Objective response occurred in 31{\%} (confidence interval, 19{\%} to 45{\%}) with paclitaxel and 35{\%} (confidence interval, 22{\%} to 51{\%}) with CMFP, with stable disease in an additional 33{\%} and 29{\%}, respectively. Median time to progression was 5.5 months with paclitaxel and 6.4 months with CMFP, with a median survival of 17.3 months for patients treated with paclitaxel and 11.3 months for those given CMFP. Grades 3 and 4 neutropenia occurred in 64{\%} of patients with paclitaxel and 63{\%} with CMFP. However, febrile neutropenia was the primary reason for hospitalization in 1{\%} of paclitaxel courses, compared with 8{\%} with CMFP. Major infections (World Health Organization grade 4) were seen in 7{\%} of patients treated with CMFP, but in none of those given paclitaxel. Moderate or severe mucositis occurred in 13{\%} of paclitaxel and 27{\%} of CMFP patients. Alopecia and peripheral neuropathy were more common with paclitaxel. Quality of life assessments in the first 100 patients suggest better overall results for those treated with paclitaxel compared with CMFP. Preliminary analyses suggest that single- agent paclitaxel is well tolerated and provides control of metastatic cancer comparable to that of CMFP combination therapy when used as front-line therapy in an outpatient setting.",
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Bishop, JF, Dewar, J, Toner, G, Tattersall, MH, Olver, I, Ackland, S, Kennedy, I, Goldstein, D, Gurney, H, Walpole, E, Levi, J & Stephenson, J 1997, 'A randomized study of paclitaxel versus cyclophosphamide/methotrexate/- fluorouracil/prednisone in previously untreated patients with advanced breast cancer: Preliminary results', Seminars in Oncology, vol. 24, no. 5 SUPPL. 17, pp. S17-5-S17-9.

A randomized study of paclitaxel versus cyclophosphamide/methotrexate/- fluorouracil/prednisone in previously untreated patients with advanced breast cancer : Preliminary results. / Bishop, J. F.; Dewar, J.; Toner, G.; Tattersall, M. H.; Olver, I.; Ackland, S.; Kennedy, I.; Goldstein, D.; Gurney, H.; Walpole, E.; Levi, J.; Stephenson, J.

In: Seminars in Oncology, Vol. 24, No. 5 SUPPL. 17, 1997, p. S17-5-S17-9.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - A randomized study of paclitaxel versus cyclophosphamide/methotrexate/- fluorouracil/prednisone in previously untreated patients with advanced breast cancer

T2 - Seminars in Oncology

AU - Bishop, J. F.

AU - Dewar, J.

AU - Toner, G.

AU - Tattersall, M. H.

AU - Olver, I.

AU - Ackland, S.

AU - Kennedy, I.

AU - Goldstein, D.

AU - Gurney, H.

AU - Walpole, E.

AU - Levi, J.

AU - Stephenson, J.

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N2 - When administered as a single agent to previously treated patients with advanced breast cancer, paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) has good activity. This trial was undertaken to compare paclitaxel with standard chemotherapy as front-line treatment for this disease. Patients with measurable or evaluable metastatic breast cancer, no prior chemotherapy for metastatic disease, and Eastern Cooperative Oncology Group performance status of 0 to 2 were randomized to receive either paclitaxel 200 mg/m2 intravenously over 3 hours for eight cycles over 24 weeks or standard treatment with oral cyclophosphamide 100 mg/m2/d days 1 to 14, intravenous methotrexate 40 mg/m2 days 1 and 8, intravenous 5- fluorouracil 600 mg/m2 days 1 and 8, and oral prednisone 40 mg/m2 daily days 1 to 14 (CMFP) for six cycles over 24 weeks. Patients whose disease progressed or relapsed were recommended for second-line therapy with epirubicin. Accrual has been completed with 209 patients randomized, and an interim analysis of the first 100 patients is reported here. Analysis of quality of life, assessed by the linear analogue scale and overall quality of life indices, is ongoing. Objective response occurred in 31% (confidence interval, 19% to 45%) with paclitaxel and 35% (confidence interval, 22% to 51%) with CMFP, with stable disease in an additional 33% and 29%, respectively. Median time to progression was 5.5 months with paclitaxel and 6.4 months with CMFP, with a median survival of 17.3 months for patients treated with paclitaxel and 11.3 months for those given CMFP. Grades 3 and 4 neutropenia occurred in 64% of patients with paclitaxel and 63% with CMFP. However, febrile neutropenia was the primary reason for hospitalization in 1% of paclitaxel courses, compared with 8% with CMFP. Major infections (World Health Organization grade 4) were seen in 7% of patients treated with CMFP, but in none of those given paclitaxel. Moderate or severe mucositis occurred in 13% of paclitaxel and 27% of CMFP patients. Alopecia and peripheral neuropathy were more common with paclitaxel. Quality of life assessments in the first 100 patients suggest better overall results for those treated with paclitaxel compared with CMFP. Preliminary analyses suggest that single- agent paclitaxel is well tolerated and provides control of metastatic cancer comparable to that of CMFP combination therapy when used as front-line therapy in an outpatient setting.

AB - When administered as a single agent to previously treated patients with advanced breast cancer, paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) has good activity. This trial was undertaken to compare paclitaxel with standard chemotherapy as front-line treatment for this disease. Patients with measurable or evaluable metastatic breast cancer, no prior chemotherapy for metastatic disease, and Eastern Cooperative Oncology Group performance status of 0 to 2 were randomized to receive either paclitaxel 200 mg/m2 intravenously over 3 hours for eight cycles over 24 weeks or standard treatment with oral cyclophosphamide 100 mg/m2/d days 1 to 14, intravenous methotrexate 40 mg/m2 days 1 and 8, intravenous 5- fluorouracil 600 mg/m2 days 1 and 8, and oral prednisone 40 mg/m2 daily days 1 to 14 (CMFP) for six cycles over 24 weeks. Patients whose disease progressed or relapsed were recommended for second-line therapy with epirubicin. Accrual has been completed with 209 patients randomized, and an interim analysis of the first 100 patients is reported here. Analysis of quality of life, assessed by the linear analogue scale and overall quality of life indices, is ongoing. Objective response occurred in 31% (confidence interval, 19% to 45%) with paclitaxel and 35% (confidence interval, 22% to 51%) with CMFP, with stable disease in an additional 33% and 29%, respectively. Median time to progression was 5.5 months with paclitaxel and 6.4 months with CMFP, with a median survival of 17.3 months for patients treated with paclitaxel and 11.3 months for those given CMFP. Grades 3 and 4 neutropenia occurred in 64% of patients with paclitaxel and 63% with CMFP. However, febrile neutropenia was the primary reason for hospitalization in 1% of paclitaxel courses, compared with 8% with CMFP. Major infections (World Health Organization grade 4) were seen in 7% of patients treated with CMFP, but in none of those given paclitaxel. Moderate or severe mucositis occurred in 13% of paclitaxel and 27% of CMFP patients. Alopecia and peripheral neuropathy were more common with paclitaxel. Quality of life assessments in the first 100 patients suggest better overall results for those treated with paclitaxel compared with CMFP. Preliminary analyses suggest that single- agent paclitaxel is well tolerated and provides control of metastatic cancer comparable to that of CMFP combination therapy when used as front-line therapy in an outpatient setting.

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