Definition: CMF is a classic chemotherapy regimen used primarily for early-stage breast cancer. The acronym stands for:
- Cyclophosphamide
- Methotrexate
- Fluorouracil (5-FU)
Components & Mechanism of Action
| Drug | Class | Mechanism of Action |
|---|---|---|
| Cyclophosphamide | Alkylating agent | Crosslinks DNA strands → inhibits DNA replication and transcription → cell death |
| Methotrexate | Antimetabolite (antifolate) | Inhibits dihydrofolate reductase → blocks DNA synthesis and repair |
| Fluorouracil (5-FU) | Antimetabolite (pyrimidine analog) | Inhibits thymidylate synthase → disrupts DNA synthesis |
Typical Dosing Schedule
| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Cyclophosphamide | 600 mg/m² | IV | Day 1 |
| Methotrexate | 40 mg/m² | IV | Days 1 and 8 |
| Fluorouracil | 600 mg/m² | IV | Days 1 and 8 |
| Cycle repeats every 28 days | Typically for 6 cycles |
Indications
- Adjuvant treatment for early-stage breast cancer (especially hormone receptor-positive or negative)
- Occasionally used in metastatic breast cancer
Common Toxicities
| Toxicity | Notes/Management |
|---|---|
| Myelosuppression | Neutropenia, anemia, thrombocytopenia; monitor CBC |
| Nausea & vomiting | Moderate emetogenic risk; use antiemetics |
| Mucositis | Methotrexate-related; oral care and supportive treatment |
| Alopecia | Less frequent/severe compared to other regimens |
| Diarrhea | Possible, monitor hydration |
| Hemorrhagic cystitis | Low risk with standard dose cyclophosphamide; encourage hydration |
Clinical Considerations
- Monitor CBC with differential regularly to guide treatment delays or dose adjustments.
- Methotrexate clearance depends on renal function; dose adjustment or delay may be required if renal impairment develops.
- Supportive care includes antiemetics, hydration, and infection prophylaxis as needed.
- Not commonly used in modern regimens but remains a reference standard and option in certain clinical scenarios.
Practice Pearls
- CMF is less commonly used today due to the advent of taxane- and anthracycline-based regimens but is still relevant in some clinical contexts.
- Always review patient renal and hepatic function before administering methotrexate.
- Educate patients on signs of infection due to neutropenia and mucositis to prevent complications.
Key Takeaway:
CMF is a well-established chemotherapy regimen for breast cancer combining alkylating and antimetabolite agents with manageable toxicity, primarily used as adjuvant therapy though less common in current practice due to newer regimens.
Synonyms
CMF