First, second and third line chemotherapy programs in metastatic breast carcinoma.

The experience with three different chemotherapeutic regimes used as first, second and third line treatment in metastatic breast carcinoma is reported. Cyclophosphamide, Methotrexate and 5-fluorouracil (CMF) were given to 117 previously untreated patients. Objective remission was seen in 49%, including 8% with complete remission (CR) for a median duration of response lasting 16 mo. CMF plus vincristine and prednisone (CMFVP) was given to 88 patients who had failed on CMF therapy. Twenty-three percent achieved an objective remission, complete (CR) in 6% and partial (PR) in 17%, and another 28% improved I), giving a Cr+PR+I rate of 51% with remission lasting a median of six months. Finally, 23 patients who failed on CMFVP chemotherapy were given adriamycin, bleomycin, vinblastine and dimethyl-triazo-imidazole-carboxamide (ABVD) as tertiary chemotherapy; 17% achieved PR and 13% improved for a median period of nine and seven months, respectively, with a median survival of eight months for this subgroup--compared with only 4.5 months for 12 patients who progressed on this third line treatment. All three regimens were relatively well tolerated. Six patients, however, developed a fatal septic shock while leukopenic on CMFVP. Cardiac and pulmonary toxicity have not been observed. The sequential administration of chemotherapeutic regimens as reported here offers the opportunity for repeated remission in patients with active metastatic breast carcinoma and results in prolonged survival for responders.