Randomized trial of cyclophosphamide, doxorubicin, and 5-fluorouracil alone or alternating with a "cycle active" non-cross-resistant combination in women with visceral metastatic breast cancer: a Southeastern Cancer Study Group project.

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Abstract
Patients with visceral patterns of metastatic breast cancer were stratified according to dominant metastatic site and performance status and then randomized to therapy with cyclophosphamide, doxorubicin and 5-fluorouracil (CAF) or CAF alternating with a cell-cycle active regimen including cytosine arabinoside, methotrexate with leucovorin rescue and oncovin (CAMELEON). Patients (187) were randomized; response rate for CAF was 44% and for CAF + CAMELEON, 40%. Durations of disease control and survival were not significantly different. Toxicity of CAF was as anticipated with predominant granulocytopenia, vomiting and alopecia. Toxicity of CAMELEON was less severe than that of CAF and CAF toxicity was not worsened by preceding courses of CAMELEON; however, the CAF-CAMELEON regimen was cumbersome and complex leading to both physician and patient noncompliance. Contrary to the preliminary results of a pilot-study, and preliminary reports of the present trial suggesting benefit for the CAF-CAMELEON regimen the present randomized trial does not confirm any significant benefit of CAF-CAMELEON over CAF alone in patients with visceral metastatic breast cancer although this conclusion must be viewed in light of the high inevaluability rate due to patient and physician noncompliance.