In general , single-agent chemotherapy is not recommended for the adjuvant treatment of breast cancer in any patient population .
Anthracycline-taxane-based polychemotherapy regimens are , overall , considered superior to earlier-generation regimens and have the most significant impact on patient survival outcomes .
Regimens with varying anthracycline and taxane doses and schedules are options ; in general , paclitaxel given every 3 weeks is inferior .
Evidence does not support the use of bevacizumab in the adjuvant setting ; other systemic therapy agents such as metformin and vaccines remain investigatory .
BACKGROUND The Program in Evidence -Based Care ( pebc ) of Cancer Care Ontario recently created an evidence -based consensus guideline on the systemic treatment of early breast cancer .
The evidence for the guideline was compiled using a systematic review to answer the question " What is the optimal systemic therapy for patients with early-stage , operable breast cancer , when patient and disease factors are considered ? "
The question was addressed in three parts : cytotoxic chemotherapy , endocrine treatment , and human epidermal growth factor receptor 2 (her2)-directed therapy .
Extended benefit from sequential administration of docetaxel after standard fluorouracil, epirubicin, and cyclophosphamide regimen for node-positive breast cancer: the 8-year follow-up results of the UNICANCER-PACS01 trial.
PURPOSE The initial report from the Programme Action Concertée Sein ( PACS ) PACS01 trial demonstrated a benefit at 5 years for disease-free survival ( DFS ) and overall survival ( OS ) rates with the sequential administration of docetaxel after FEC100 ( fluorouracil 500 mg/m(2 ) , epirubicin 100 mg/m(2 ) , and cyclophosphamide 500 mg/m(2 ) ) for patients with node-positive , operable breast cancer . We evaluate here the impact of this regimen at 8 years . PATIENTS AND METHODS Between June 1997 and March 2000 , a total of 1,999 patients ( age < 65 ) with localized , resectable , non-pretreated , unilateral breast cancer were r and omly assigned to receive either st and ard FEC100 for 6 cycles or 3 cycles of FEC100 followed by 3 cycles of 100 mg/m(2 ) docetaxel ( FEC-D ) , both given every 21 days . Radiotherapy was m and atory after conservative surgery and tamoxifen was given for 5 years to hormone receptor (HR)-positive patients . Five-year DFS was the trial 's main endpoint . Up date d 8-year survival data are presented . RESULTS With a median follow-up of 92.8 months , 639 patients experienced at least one event . A total number of 383 deaths were registered . Eight-year DFS rates were 65.8 % with FEC alone and 70.2 % with FEC-D.  OS rates at 8 years were 78 % with FEC alone and 83.2 % with FEC-D. Cox regression analysis adjusted for age and number of positive nodes showed a 15 % reduction in the relative risk of relapse and a 25 % reduction in the relative risk of death in favor of FEC-D. Significant relative risk reductions were observed in the HR-positive , HER2-positive , and Ki67 ≥20 % sub population s. CONCLUSION Benefits for DFS and OS rates with the sequential FEC-D regimen are fully confirmed at 8 years
In general , single-agent chemotherapy is not recommended for the adjuvant treatment of breast cancer in any patient population .
Anthracycline-taxane-based polychemotherapy regimens are , overall , considered superior to earlier-generation regimens and have the most significant impact on patient survival outcomes .
Regimens with varying anthracycline and taxane doses and schedules are options ; in general , paclitaxel given every 3 weeks is inferior .
Evidence does not support the use of bevacizumab in the adjuvant setting ; other systemic therapy agents such as metformin and vaccines remain investigatory .
BACKGROUND The Program in Evidence -Based Care ( pebc ) of Cancer Care Ontario recently created an evidence -based consensus guideline on the systemic treatment of early breast cancer .
The evidence for the guideline was compiled using a systematic review to answer the question " What is the optimal systemic therapy for patients with early-stage , operable breast cancer , when patient and disease factors are considered ? "
The question was addressed in three parts : cytotoxic chemotherapy , endocrine treatment , and human epidermal growth factor receptor 2 (her2)-directed therapy .