How do you decide to choose TC vs CMF for HER2 negative breast cancer patients who warrant adjuvant chemotherapy?
There are various modifications of CMF. Most of the data on the efficacy of CMF is based on the "classic" dose and scheduling, i.e. IV MTX and 5-FU on day 1 and 8, and oral cyclophosphamide on day 1-14 of a 28-day cycle. [Historically, this regimen was developed to duplicate the schedule of the highly effective MOPP regimen for Hodgkin's Disease.] Other schedules, notably IV CMF given day 1 of a 21-day cycle, have been shown to be inferior to the classic regimen, at least in the metastatic setting. (Goldhirsch et al, Ann Oncol, 9:489, 1998)
Classic CMF was found to be effective in the adjuvant setting and was subsequently found to be similar in efficacy to anthracycline/cyclophosphamide regimens. TC has subsequently been shown to be superior...
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I agree. I choose TC. However, if my patient has a severe reaction to Docetaxel, my practice is to administer CMF.
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