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 .
Menstrual history and quality-of-life outcomes in women with node-positive breast cancer treated with adjuvant therapy on the NSABP B-30 trial.
PURPOSE Premenopausal women with breast cancer receiving adjuvant chemotherapy  are at risk for amenorrhea . The National Surgical Adjuvant Breast and Bowel Project B-30 trial included menstrual history ( MH ) and quality -of-life ( QOL ) studies to compare treatments on these outcomes . PATIENTS AND METHODS Patients were r and omly assigned to sequential doxorubicin ( A ) and cyclophosphamide ( C ) followed by docetaxel ( T ; AC→T ) , concurrent TAC , or AT , which varied in duration ( 24 , 12 , 12 weeks , respectively ) , and use of C. Endocrine therapy was prescribed for women with hormone receptor-positive tumors .  MH and QOL were assessed with st and ardized question naires at baseline ; cycle 4 , day 1 ; and every 6 months through 24 months . Prespecified analyses examined rates of amenorrhea by treatment arm , the relationship between amenorrhea and QOL , and QOL by treatment arm . RESULTS Amenorrhea 12 months after r and om assignment was significantly different between treatment groups : 69.8 % for AC→T , 57.7 % for TAC , and 37.9 % for AT ( P < .001 ) . The AT group without tamoxifen had the lowest rate of amenorrhea . QOL was poorer for patients receiving AC→T at 6 months but similar to others by 12 months . Post-treatment symptoms were increased above baseline for all treatments . Multivariable repeated measures modeling demonstrated that treatment arm , time point , age , and tamoxifen use were significantly associated with symptom severity ( all P values < .002 ) . CONCLUSION Amenorrhea rates differed significantly by treatment arm , with the AT arm having the lowest rate . Patients treated with longer duration therapy ( AC→T ) had greater symptom severity and poorer QOL at 6 months , but did not differ from shorter duration treatments at 12 months
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 .