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 .
Comparison of predictive and prognostic impact of molecular subtypes and central grade regarding taxane-based therapy in intermediate-risk breast cancer: Results from the EC-Doc trial.
10625 Background : Patients with hormone receptor positive breast cancer and 1 - 3 positive lymph nodes ( LN ) belong to the intermediate risk-group . Among these patients chemo-endocrine therapy may be considered according to the St. Gallen guidelines . We compared evidence -based cut-offs of Ki-67 for definition of molecular subtypes to central grade regarding their predictive value for benefit from taxane-based chemotherapy . METHODS The EC-Doc trial r and omized 1950 patients with 1 - 3 positive LN to 6x CEF/CMF vs. 4xEC-4xDoc .  Significantly better DFS and OS favoring EC-Doc have been previously reported ( Nitz et al. , SABCS 2008 ) . Protein expression data ( ER , PR , HER2[+FISH ] , Ki-67 , Ck 5 , and EGFR ) and central histology/ grade were available for 772 patients . Molecular subgroups were classified using Ki-67 cut-off 's of 13.25 % and 20 % ( due to correlation with genomic grade index [ GGI ] ) . GGI analysis is planned . RESULTS The entire and the investigated study population s did not differ regarding baseline characteristics . After median follow up of 64 months , both DFS ( 5y 90 % vs. 80 % , p=0.006 ) and OS ( 5y 95 % vs. 92 % , p=0.022 ) rates significantly favored EC-Doc vs. CEF also in this cohort . 5-y DFS was longest in luminal A and shortest in basal-like tumors ( 97 % vs. 72 % , p<0.001 ) . Both Ki-67 cut-offs ( 13.25 % and 20 % ) used for defining luminal B subtype were predictive for taxane benefit . However , only Ki-67 cut-off of 20 % was significant regarding interaction with therapy ( HR=0.467 , p=0.02 ) in multivariate analysis including central grade , age , nodal status , tumor size , molecular subtypes , therapy , and predictive interactions between all factors and therapy . Only central grade ( HR=4.315 , p<0.001 ) and luminal A subtype ( HR=0.343 , p<0.001 ) were shown as significant prognostic factors for the whole collective . CONCLUSIONS These data provide evidence that luminal B subtype defined by HR positive and KI-67>20 % or HER2 + is the only predictive factor for taxane benefit in intermediate risk BC and that both central grade and luminal A subtype are strong prognostic markers . These results are currently vali date d within the prospect i ve WSG PlanB trial
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 .