Vinblastine, adriamycin, and cyclophosphamide in the treatment of adenocarcinoma of the breast

Thirty-two stage IV patients and one stage III patient with evaluable adenocarcinoma of the breast received treatment with vinblastine, adriamycin, and cyclophosphamide. One patient was unevaluable because of early death. Twenty-two of 32 patients (69%) achieved complete or partial remissions and seven (22%) stabilized, including two (6%) minor responses. One of the three (9%) patients failing treatment had had extensive prior chemotherapy. Five of seven patients over the age of 70 years achieved partial remissions. A sixth had a minor response. Three of five performance status 3 and one of two performance status 4 patients responded. Overall response rate (p less than 0.01) and complete remission rate (p less than 0.05) were greatest in soft tissue disease. Granulocytopenia was dose-limiting, and recommended starting doses are vinblastine 4 mg/m2, adriamycin 40 mg/m2, and cyclophosphamide 400 mg/m2. These doses produce granulocytopenia in the majority of patients, but recovery is rapid. Overall, this is a well-tolerated regimen comparable in efficacy to other adriamycin-containing combinations. Use of standard white blood count criteria instead of granulocyte criteria for determining dose alterations and time of retreatment would have resulted in markedly excessive dose reductions and treatment delays and in a marked reduction in permitted dose escalations. This could potentially have reduced the response rate.