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document
A randomized comparative trial of combined versus alternating therapy with cytostatic drugs and high-dose medroxyprogesteron acetate in advanced breast cancer . A prospective multicenter trial was conducted in 155 consecutive patients with Stage IV breast cancer randomly allocated to receive either ( 1 ) vincristin ( V ) 1.2 mg/m2 ( maximum dose , 2 mg ) , Adriamycin ( A ) ( doxorubicin ) 40 mg/m2 , and cyclophosphamide ( C ) 500 mg/m2 , all intravenously on day 1 , every 4 weeks , in combination with medroxyprogesteron acetate ( MPA ) 600 mg orally on days 1 through 14 , 500 mg intramuscularly on days 1 through 28 , and twice weekly afterwards ( combined chemoendocrine approach ) or ( 2 ) the same combination chemotherapy ( VAC ) for three cycles alternating with MPA in the above-mentioned dosage during 8 weeks ( alternating chemoendocrine approach ) . Results show an overall response rate of 73 % with 26 % complete responses in the combined treatment arm , whereas in the alternating arm , an overall response rate of 76 % with 20 % complete responses was observed . In patients with more than one metastatic site , response rate was higher in the combination treatment , and only in this arm were complete responses observed in these patients . Although the median duration of response was long in both treatment arms ( combination , 19 months versus alternating , 21 months ) , the median overall survival in both groups was not definitely prolonged ( 22 versus 24 months , respectively ) . However , results in subsets of patients suggest that the alternating chemoendocrine approach may be better for estrogen receptor ( ER ) -negative patients , for patients younger than 51 years of age , and for patients with a disease-free interval of 1 year or less . Patients with these parameters probably belong to the same population . It is concluded that combination of chemotherapy and high-dose MPA may be indicated in ER-positive patients when a clinical response is urgently needed . In ER-negative patients , the alternating use of both treatment modalities deserves further investigation .
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Intervention_Pharmacological
vincristin ( V )
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Intervention_Pharmacological
Adriamycin ( A ) ( doxorubicin )
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Intervention_Pharmacological
cyclophosphamide ( C )
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Intervention_Pharmacological
medroxyprogesteron acetate ( MPA )
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Outcome_Other
overall response rate
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Outcome_Other
overall response rate
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Outcome_Other
response rate
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Outcome_Other
median duration of response was long
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Outcome_Mortality
overall survival
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Outcome_Other
combination of chemotherapy and high-dose MPA may be indicated in ER-positive patients
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Participant_Condition
advanced breast cancer
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Participant_Sample-size
155