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 .
Long-term benefit of high-dose epirubicin in adjuvant chemotherapy for node-positive breast cancer: 15-year efficacy results of the Belgian multicentre study.
PURPOSE The 4-year results of this trial demonstrated that a higher dose of epirubicin with cyclophosphamide ( HEC ) is superior to a lower dose of epirubicin , 60 mg/m(2 ) ( EC ) , for event-free survival ( EFS ; 27 % reduction ) , but is not superior to classical oral cyclophosphamide , methotrexate , and fluorouracil ( CMF ) in the adjuvant treatment of node-positive breast cancer . Herein we report the 15-year data on efficacy and long-term toxicity of this three-arm Belgian multicenter trial . PATIENTS AND METHODS Between March 1988 and December 1996 , 777 eligible patients were r and omly assigned to six cycles of CMF , eight cycles of EC , or eight cycles HEC . RESULTS The 15-year EFS was 45 % for patients who received CMF , 39 % for patients who received EC , and 50 % for patients who received HEC . The hazard ratios ( HR ) were 0.77 for HEC versus EC ( 95 % CI , 0.60 to 0.98 ; P = .03 ) , 0.90 for HEC versus CMF ( P = .39 ) , and 0.86 for EC versus CMF ( P = .21 ) . No difference in overall survival ( OS ) was seen . Cardiac toxicity was more frequent with HEC than with CMF ( 11 patients v 1 patient ; P = .006 ) , but no more than with EC ( P = .21 ) . CONCLUSION Treatment with HEC demonstrated superior EFS when compared with lower-dose epirubicin . However , we do not recommend the use of HEC regimen in daily clinical practice , mainly because of the higher risk of cardiotoxicity related to the cumulative doses of epirubicin and the lack of superiority of anthracyclines over CMF in our study
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 .