CMF: Cyclophosphamide, methotrexate, and fluorouracil

CMF (cyclophosphamide, methotrexate, and fluorouracil) is a chemotherapy regimen used to treat early-stage breast cancer that has not spread beyond the breast or lymph nodes.

CMF is a combination of three medicines:

• Cyclophosphamide (Cytoxan), a type of medicine called an alkylating agent
• Methotrexate (Amethopterin, Folex, Mexate, Rheumatrex), an antimetabolite chemotherapy medicine
• Fluorouracil (5-FU), an antimetabolite chemotherapy medicine

How CMF works

Each medicine attacks the cancer cells in a different way:

• Cyclophosphamide stops cancer cells from reproducing.
• Methotrexate and fluorouracil stop cells from making and fixing DNA. This causes the cells to die when they try to divide.

Who gets CMF

CMF has been found to be effective for both node-negative disease that hasn’t traveled to lymph nodes and node-positive disease that has spread to lymph nodes. It is used as adjuvant therapy, after surgery, for early-stage breast cancer. CMF is the only chemotherapy regimen that can be given at the same time as radiation therapy, but this is not commonly done.

You and your doctor will discuss the best chemotherapy treatment for your situation.

How CMF is given

CMF can be given three different ways:

1) All three medicines together, by vein, on the first day of treatment, followed by a 3-week rest period.

• This cycle is usually repeated 4 to 6 times over 3 to 6 months.

2) Cyclophosphamide by mouth as a daily pill for 14 days

• Methotrexate and flourouracil together, by vein, on days 1 and 8 of that 2-week period.
• When you finish your cyclophosphamide pills, you’ll have a 2-week rest period.
• This 4-week cycle is usually repeated 4 to 6 times for a total of 3 to 6 months.

3) All three medicines together, by vein, on the first day of treatment.

• This is repeated one week later and followed by a 3-week rest period.
• This cycle is usually repeated 4 to 6 times for a total of 3 to 6 months.

Side effects and things to remember

Different medicines have different side effects. You may not have every side effect related to each medicine of the combination therapy. Common side effects of CMF include:

• Low blood counts (including white blood cells, red blood cells, and platelets)
• Risk of infection
• Bruising or bleeding
• Nausea and vomiting
• Loss of appetite
• Mouth sores
• Diarrhea
• Fatigue
• Eye problems
• Bladder irritation
• Hair loss
• Menopausal symptoms

Less common side effects include:

• Nail and skin changes
• Heart problems
• Kidney and liver problems

Before starting CMF, be sure to tell your doctor about any medicines you are taking—including vitamins, herbal supplements, and over-the-counter medicines—to make sure they won’t interfere with your chemotherapy treatment.

You will need a blood test before you start treatment. Contact your doctor right away if you develop a fever or other symptoms of an infection such as a sore throat, cough or diarrhea.

You should avoid becoming pregnant while you are receiving CMF. Tell your doctor right away if you become pregnant or may be pregnant while you are getting treatment.

Be sure to talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. You can also go to our section on Side effects for more information.