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 .
Definitive results of a phase III adjuvant trial comparing three chemotherapy regimens in women with operable, node-positive breast cancer: the NSABP B-38 trial.
PURPOSE Anthracycline- and taxane-based three-drug chemotherapy regimens have proven benefit as adjuvant therapy for early-stage breast cancer . This trial ( NSABP B-38 ; Combination Chemotherapy in Treating Women Who Have Undergone Surgery for Node-Positive Breast Cancer ) asked whether the incorporation of a fourth drug could improve outcomes relative to two st and ard regimens and provided a direct comparison of those two regimens . PATIENTS AND METHODS We r and omly assigned 4,894 women with node-positive early-stage breast cancer to six cycles of docetaxel , doxorubicin , and cyclophosphamide ( TAC ) , four cycles of dose-dense ( DD ) doxorubicin and cyclophosphamide followed by four cycles of DD paclitaxel ( P ; DD AC→P ) , or DD AC→P with four cycles of gemcitabine ( G ) added to the DD paclitaxel ( DD AC→PG ) . Primary granulocyte colony-stimulating factor support was required ; erythropoiesis-stimulating agents ( ESAs ) were used at the investigator 's discretion . RESULTS There were no significant differences in 5-year disease-free survival ( DFS ) between DD AC→PG and DD AC→P ( 80.6 % v 82.2 % ; HR , 1.07 ; P = .41 ) , between DD AC→PG and TAC ( 80.6 % v 80.1 % ; HR , 0.93 ; P = .39 ) , in 5-year overall survival ( OS ) between DD AC→PG and DD AC→P ( 90.8 % v 89.1 % ; HR , 0.85 ; P = .13 ) , between DD AC→PG and TAC ( 90.8 % v 89.6 % ; HR , 0.86 ; P = .17 ) , or between DD AC→P versus TAC for DFS ( HR , 0.87 ; P = .07 ) and OS ( HR , 1.01 ; P = .96 ) . Grade 3 to 4 toxicities for TAC , DD AC→P , and DD AC→PG , respectively , were febrile neutropenia ( 9 % , 3 % , 3 % ; P < .001 ) , sensory neuropathy ( < 1 % , 7 % , 6 % ; P < .001 ) , and diarrhea ( 7 % , 2 % , 2 % ; P < .001 ) . Exploratory analyses for ESAs showed no association with DFS events ( HR , 1.02 ; P = .95 ) . CONCLUSION Adding G to DD AC→P did not improve outcomes . No significant differences in efficacy were identified between DD AC→P and TAC , although toxicity profiles differed
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 .