To the Editor.
—Although I applaud the attempt of Dr Bonadonna and colleagues1 to improve treatment results in women with breast cancer involving more than three axillary nodes, I believe for several reasons that the data presented in their article do not yet justify the acceptance of the sequential regimen (four courses of doxorubicin hydrochloride followed by eight courses of cyclophosphamide, methotrexate, and fluorouracil [CMF]) as standard therapy for women in this category. First, although the authors demonstrate that sequential treatment is superior to alternating treatment, they do not address the possibility, raised by others, that alternating therapy for breast cancer may actually be less effective than more standard continuous regimens.2 Thus, although sequential treatment is better than alternating treatment, it may not be any better than standard continuous treatments. Second, the authors believe that the results of their treatment are superior to those reported in other series
Michaelson RA. Doxorubicin Followed by Cyclophosphamide, Methotrexate, and Fluorouracil for Breast Cancer. JAMA. 1995;274(10):796. doi:10.1001/jama.1995.03530100036022