{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T04:10:33Z","timestamp":1768277433650,"version":"3.49.0"},"reference-count":26,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2002,12,18]],"date-time":"2002-12-18T00:00:00Z","timestamp":1040169600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2003,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Adjuvant combination chemotherapy with cyclophosphamide, methotrexate, and 5\u2010fluorouracil plus vincristine and prednisone (CMFVP) was compared with single\u2010agent L\u2010phenylalanine mustard (L\u2010PAM) for the treatment of patients with axillary lymph node positive primary breast carcinoma over 20\u2010years of follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Four hundred forty\u2010one women with axillary lymph node positive breast carcinoma were randomized to receive either combination chemotherapy with cyclophosphamide (60 mg\/m<jats:sup>2<\/jats:sup> orally every day for 1 year), fluorouracil (300 mg\/m<jats:sup>2<\/jats:sup> intravenously [IV] weekly for 1 year), methotrexate (15 mg\/m<jats:sup>2<\/jats:sup> IV weekly for 1 year), vincristine (0.625 mg\/m<jats:sup>2<\/jats:sup> IV for 10 weeks), prednisone (30 mg\/m<jats:sup>2<\/jats:sup> orally on Days 1\u201314, 20 mg\/m<jats:sup>2<\/jats:sup> on Days 15\u201328, and 10 mg\/m<jats:sup>2<\/jats:sup> on Days 29\u201342), or single\u2010agent chemotherapy with L\u2010PAM (5 mg\/m<jats:sup>2<\/jats:sup> orally every day for 5 days every 6 weeks for 2 years) after undergoing surgery. Patients were stratified according to menopausal status and number of positive lymph nodes (1\u20133 positive lymph nodes or &gt; 3 positive lymph nodes). Seventy\u2010seven patients were ineligible.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The maximum follow\u2010up is 24 years, with a median follow\u2010up of 21.5 years. Disease free survival and overall survival were superior with CMFVP (two\u2010sided log\u2010rank test; <jats:italic>P<\/jats:italic> = 0.0008 and <jats:italic>P<\/jats:italic> = 0.007, respectively). For all patients, the estimated 20\u2010year survival rate of patients who received CMFVP was 40% compared with 27% for patients who received L\u2010PAM. There was a substantial survival benefit for CMFVP compared with L\u2010PAM in the subsets of premenopausal patients and patients with four or more positive lymph nodes. The estimated 20\u2010year survival rate for premenopausal women who received CMFVP was 49% compared with 33% for premenopausal women who received L\u2010PAM. Among women with \u2265 4 positive lymph nodes, the estimated survival rate for patients who received CMFVP was 31% compared with 15% for patients who received L\u2010PAM. Both regimens were tolerated well. Toxicity was more severe and frequent among patients who received CMFVP.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The authors conclude that, after 20 years of follow\u2010up, adjuvant chemotherapy with CMFVP remains superior to L\u2010PAM for the treatment of patients with lymph node positive breast carcinoma. Cancer 2003;97:21\u20139. \u00a9 2003 American Cancer Society.<\/jats:p><jats:p>DOI 10.1002\/cncr.10982<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.10982","type":"journal-article","created":{"date-parts":[[2002,12,19]],"date-time":"2002-12-19T08:57:58Z","timestamp":1040288278000},"page":"21-29","source":"Crossref","is-referenced-by-count":8,"title":["Adjuvant chemotherapy with cyclophosphamide, methotrexate, and 5\u2010fluorouracil, vincristine, and prednisone compared with single\u2010agent L\u2010phenylalanine mustard for patients with operable breast carcinoma and positive axillary lymph nodes"],"prefix":"10.1002","volume":"97","author":[{"given":"Saul E.","family":"Rivkin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie J.","family":"Green","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danika","family":"Lew","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John J.","family":"Costanzi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John W.","family":"Athens","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. 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