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 .
Sequential adjuvant epirubicin-based and docetaxel chemotherapy for node-positive breast cancer patients: the FNCLCC PACS 01 Trial.
PURPOSE The PACS 01 trial compared six cycles of fluorouracil , epirubicin , and cyclophosphamide ( FEC ) with a sequential regimen of three cycles of FEC followed by three cycles of docetaxel ( FEC-D ) as adjuvant treatment for women with node-positive early breast cancer . PATIENTS AND METHODS Between June 1997 and March 2000 , 1,999 patients with operable node-positive breast cancer were r and omly assigned to either FEC every 21 days for six cycles , or three cycles of FEC followed by three cycles of docetaxel , both given every 21 days . Hormone-receptor-positive patients received tamoxifen for 5 years after chemotherapy . The primary end point was 5-year disease-free survival ( DFS ) . RESULTS Median follow-up was 60 months . Five-year DFS rates were 73.2 % with FEC and 78.4 % with FEC-D ( unadjusted P = .011 ; adjusted P = .012 ) . Multivariate analysis adjusted for prognostic factors showed an 18 % reduction in the relative risk of relapse with FEC-D.  Five-year overall survival rates were 86.7 % with FEC and 90.7 % with FEC-D , demonstrating a 27 % reduction in the relative risk of death ( unadjusted P = .014 ; adjusted P = .017 ) . The incidence of grade 3 to 4 neutropenia , the need for hematopoietic growth factor , and incidence of nausea/vomiting were higher with FEC . Docetaxel was associated with more febrile neutropenia in the fourth cycle , stomatitis , edema , and nail disorders . Though rare overall , there were fewer cardiac events after FEC-D ( P = .03 ) , attributable mainly to the lower anthracycline cumulative dose . CONCLUSION Sequential adjuvant chemotherapy with FEC followed by docetaxel significantly improves disease-free and overall survival in node-positive breast cancer patients and has a favorable safety profile
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 .