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 .
Six cycles of doxorubicin and cyclophosphamide or Paclitaxel are not superior to four cycles as adjuvant chemotherapy for breast cancer in women with zero to three positive axillary nodes: Cancer and Leukemia Group B 40101.
PURPOSE The ideal duration of adjuvant chemotherapy for patients with lower risk primary breast cancer is not known . Cancer and Leukemia Group B trial 40101 was conducted using a phase III factorial design to define whether six cycles of a chemotherapy regimen are superior to four cycles . We also sought to determine whether paclitaxel ( T ) is as efficacious as doxorubicin/cyclophosphamide ( AC ) , but with reduced toxicity . PATIENTS AND METHODS Between 2002 and 2008 , the study enrolled women with operable breast cancer and zero to three positive nodes . Patients were r and omly assigned to either four or six cycles of either AC or T. Study stratifiers were estrogen receptor/progesterone receptor ( ER/PgR ) , human epidermal growth factor receptor 2 ( HER2 ) , and menopausal status . After 2003 , all treatment was administered in dose-dense fashion . The primary efficacy end point was relapse-free survival ( RFS ) . RESULTS A total of 3,171 patients were enrolled ; 94 % were node-negative and 6 % had one to three positive nodes . At a median follow-up of 5.3 years , the 4-year RFS was 90.9 % and 91.8 % for six and four cycles , respectively . The adjusted hazard ratio ( HR ) of six to four cycles regarding RFS was 1.03 ( 95 % CI , 0.84 to 1.28 ; P=.77 ) . The 4-year OS was 95.3 % and 96.3 % for six and four cycles , respectively , with an HR of six to four cycles of 1.12 ( 95 % CI , 0.84 to 1.49 ; P=.44 ) . There was no interaction between treatment duration and chemotherapy regimen , ER/PgR , or HER2 status on RFS or OS . CONCLUSION For women with resected primary breast cancer and zero to three positive nodes , we found no evidence that extending chemotherapy regimens of AC or single-agent T from four to six cycles improves clinical outcome
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 .