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 .
Prospective randomized trial of 5-fluorouracil, doxorubicin, and cyclophosphamide (FAC) versus paclitaxel and FAC (TFAC) in patients with operable breast cancer: impact of taxane chemotherapy on locoregional control
A previous r and omized trial ( CALGB 9344/Intergroup 0148 ) compared four cycles of adjuvant doxorubicin/cyclophosphamide ( AC ) to four cycles of AC plus four cycles of paclitaxel ( AC + T ) and demonstrated that the addition of paclitaxel  improved locoregional control ( LRC ) in patients with node-positive breast cancer . However , it could not be determined whether it was the paclitaxel or the increased duration of chemotherapy that led to this improvement . The present study aim ed to analyze whether the addition of paclitaxel to a doxorubicin-based regimen  improves LRC in a cohort of patients who all received eight total cycles of chemotherapy . Five hundred eleven women with operable breast cancer were r and omized on a single-institution prospect i ve trial to receive 5-fluorouracil , doxorubicin , cyclophosphamide ( FAC ) × 8 cycles ( n = 252 ) or FAC × 4 cycles plus paclitaxel × 4 cycles ( TFAC ) ( n = 259 ) . Rates of LRC and overall survival ( OS ) were analyzed . Median follow-up was 124 months ( range 5–167 months ) . The 10-year LRC rate was 92.6 versus 93.1 % in the FAC versus TFAC arms , respectively ( P = 0.26 ) . The LRC between treatment arms did not differ when analyzed by locoregional treatment group : breast conservation therapy ( BCT ) , mastectomy alone ( M ) , and mastectomy + radiation ( M + RT ) . The 10-year LRC rates were 95.1 % ( FAC ) versus 91.2 % ( TFAC ) after BCT ( P = 0.98 ) , 89.5 % ( FAC ) versus 93.4 % ( TFAC ) after M ( P = 0.24 ) , and 94.7 % ( FAC ) versus 96.5 % ( TFAC ) after M + RT ( P = 0.59 ) . Additionally , there was no difference in OS between the treatment arms , with 10-year OS rates of 78.4 % ( FAC ) versus 81.7 % ( TFAC ) ( P = 0.93 ) . The addition of paclitaxel to a doxorubicin-based regimen had no impact on LRC , regardless of the type of local therapy received . Historically inferior LRC with AC chemotherapy alone versus AC + T may have been due to an inadequate duration of systemic therapy and not due to the absence of paclitaxel
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 .