Results of salvage hormonal therapy and salvage chemotherapy in women failing adjuvant chemotherapy after mastectomy for breast cancer

We have evaluated the results of salvage systemic therapy in 257 patients with breast cancer recurrent after surgical adjuvant treatment with cyclophosphamide, fluorouracil, and prednisone (CFP) with or without tamoxifen. The overall objective response rate to salvage hormonal therapy was 29% (47 responses in 161 patients) and to salvage chemotherapy was 28% (43 responses in 156 patients). Response rates to salvage chemotherapy were similar whether or not prior salvage hormonal therapy or local modalities had been administered. Retreatment with CFP as a salvage chemotherapy yielded responses in 11 of 44 patients (25%). Response rates were similar for patients who began salvage CFP ≤12 months or >12 months after completion of adjuvant CFP. We conclude that when this unselected population of patients failing adjuvant CFP is considered, 1) response rates to salvage chemotherapy were low regardless of whether or not prior salvage hormonal or local therapies were given, 2) repeating adjuvant chemotherapy (CFP) following relapse produced a low response rate, and 3) response rates to salvage hormonal therapy were low, but on the order of those observed in patients with advanced disease unselected by estrogen receptor status who are treated with first line hormonal maneuvers.