Myeloid Toxicity in Breast Cancer Patients Receiving Adjuvant Chemotherapy With Pegfilgrastim Support

In the discussion of the article by Hutchins et al 1 it is stated that both the hazard ratios for disease-free survival and overall survival show a narrow advantage for cyclophosphamide, doxorubicin, and fluorouracil that was not as strong as had been hypothesized.Furthermore, it was stated that the two-sided statistical test was not statistically significant.Later in the discussion, it is stated that the benefit seen in hormone receptor-positive patients was dramatic.It is clear that the disease-free survival is 6% different in favor of tamoxifen in the hormone receptor-positive patients, but this difference appears to be largely due to a reduction in opposite breast recurrences.Moreover, the difference in overall survival is exactly the same as the difference between cyclophosphamide, methotrexate, and fluorouracil and cyclophosphamide, doxorubicin, and fluorouracil, which is 82% with no tamoxifen versus 85% with tamoxifen.There was a one-sided P test, which was significant, but there is no discussion of the two-sided P test.In fact, it appears that if you treat hormonepositive, node-negative breast cancer with chemotherapy the effect of tamoxifen on survival is minimal.