Phase III trial comparing two dose levels of epirubicin combined with cyclophosphamide with cyclophosphamide, methotrexate, and fluorouracil in node-positive breast cancer.

PURPOSE: To compare a full-dose epirubicin-cyclophosphamide (HEC) regimen with classical cyclophosphamide, methotrexate, and fluorouracil (CMF) therapy and with a moderate-dose epirubicin-cyclophosphamide regimen (EC) in the adjuvant therapy of node-positive breast cancer. PATIENTS AND METHODS: Node-positive breast cancer patients who were aged 70 years or younger were randomly allocated to one of the following treatments: CMF for six cycles (oral cyclophosphamide); EC for eight cycles (epirubicin 60 mg/m(2), cyclophosphamide 500 mg/m(2); day 1 every 3 weeks); and HEC for eight cycles (epirubicin 100 mg/m(2), cyclophosphamide 830 mg/m(2); day 1 every 3 weeks). RESULTS: Two hundred fifty-five, 267, and 255 eligible patients were treated with CMF, EC, and HEC, respectively. Patient characteristics were well balanced among the three arms. One and three cases of congestive heart failure were reported in the EC and HEC arms, respectively. Three cases of acute myeloid leukemia were reported in the HEC arm. After 4 years of median follow-up, no statistically significant differences were observed between HEC and CMF (event-free survival [EFS]: hazards ratio [HR] = 0.96, 95% confidence interval [CI], 0.70 to 1.31, P =.80; distant-EFS: HR = 0.97, 95% CI, 0.70 to 1.34, P =.87; overall survival [OS]: HR = 0.97, 95% CI, 0.65 to 1.44, P =.87). HEC is more effective than EC (EFS: HR = 0.73, 95% CI, 0.54 to 0.99, P =.04; distant-EFS: HR = 0.75, 95% CI, 0.55 to 1.02, P =.06; OS HR = 0.69, 95% CI, 0.47 to 1.00, P =.05). CONCLUSION: This three-arm study does not show an advantage in favor of an adequately dosed epirubicin-based regimen over classical CMF in the adjuvant therapy of node-positive pre- and postmenopausal women with breast cancer. Moreover, this study confirms that there is a dose-response curve for epirubicin in breast cancer adjuvant therapy.

[Bilateral breast masses]. / Masses mammaires bilatérales.

A 76 year old woman is hospitalized for bilateral breast masses and neurological impairment. Her medical history is marked by rheumatoid arthritis treated with gold salts and methylprednisolone. Blood tests reveal pancytopenia; the MRI scan of the brain is suggestive of a CNS lymphoma. The pathologic examination of a breast mass specimen confirms the lymphoid nature of the neoplasm. This case report highlights the multifocal or systemic nature of non hodgkin's lymphoma and the diagnostic pitfalls of breast lymphomas. Rheumatoid arthritis and its medical management are reviewed for their possible roles in oncogenesis.

[Interstitial pneumopathy caused by melphalan]. / Pneumopathie interstitielle au melphalan.

The Authors have described a case of interstitial pneumonia due to 1-phenyl alanine (Melphalan). This case report, where a diagnosis of myeloma of the lung was excluded, was characterised by contact with a single cytotoxic agent in low doses and a short delay before the appearance of the pneumopathy. The different cytotoxic substances capable of inducing such pulmonary lesions are recalled as well as the mechanisms responsible for the phenomenon. The Authors compare their observations to the 5 well documented cases in the literature and suggest that hypersensitivity may have been a contributory factor in their case.