CMF with or without medical castration in pre-menopausal women with node positive breast cancer

ABSTRACT

The prognosis of breast cancer in young women is generally considered to be unfavorable. Thus adjuvant therapy post surgical intervention is essential in many patients especially those with high risk [e.g large tumors or positive nodes]. However the presence of steroid hormone receptors in the primary tumors of young ladies may represent a suitable target for therapy in this group of patients. In the current study 100 premenopausal women with positive axillary lymph nodes and have estrogen and/or progestrone receptor positive tumors were randomized after local therapy of the breast cancer into two groups; Group I received adjuvant chemotherapy CMF for a total of six cycles then medical castration with LHRH agonist for two years and Group II received the same chemotherapy as in group I for six cycles. Adjuvant radiotherapy was given in the majority of patients in both treatment groups. After median follow up of six years, there was no statistical significance difference between both groups as regard the disease free or overall survival P=0.537 and 0.526 respectively. The toxicity reported in both groups was quite mild with only increase in the rate of hot flashes in the medical castration group. This study confirm the safety and tolerability of addition of medical castration to adjuvant chemotherapy which can be easily accepted by young women because of its reversible action, however it didn't answer many important questions about the optimum duration of ovarian suppression and the need for combined hormonal therapy like addition of tamoxifen to ovarian castration and sequence of different therapy