Threshold Dose in the Treatment of Breast Cancer

The Cancer and Leukemia Group B (CALGB) did a randomized trial evaluating different doses and dose intensities of adjuvant chemotherapy in patients with node-positive breast cancer: 1572 patients were randomized to receive CAF at three dose levels: low-dose (5-flurouracil 300 mg/mL, doxorubicin 30 mg/mL, cyclophosphamide 300 mg/mL), moderate dose (5-fluorouracil 400 mg/mL, doxorubicin 40 mg/mL, cyclophosphamide 400 mg/mL), and high dose (5-fluorouracil 600 mg/mL, doxorubicin 60 mg/mL, cyclophosphamide 600 mg/mL). Women treated in the moderate- and high-dose-intensity groups had significantly longer disease-free and overall survival than those in the low-dose group. Survival was not different between the moderate- and high-dose groups (9). This study validated the idea of a threshold dose in the treatment of breast cancer.

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