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 .
BCIRG 001 Molecular Analysis: Prognostic Factors in Node-Positive Breast Cancer Patients Receiving Adjuvant Chemotherapy
Purpose : There are currently no vali date d factors predictive of response to taxanes in patients with breast cancer . We analyzed specimens from patients included in the Breast Cancer International Research Group ( BCIRG ) 001 trial , a r and omized study which showed the superiority of docetaxel/doxorubicin/cyclophosphamide over fluorouracil/doxorubicin/cyclophosphamide as adjuvant therapy for node-positive operable breast cancer in terms of disease-free survival ( DFS ) and overall survival ( OS ) . Experimental Design : Immunohistochemical assessment of biological markers included histologic grade , tumor size , estrogen and progesterone receptors , lymph node status , HER2 , MUC1 , Ki-67/MIB-1 , p53 , Bcl-2 , Bax , Bcl-XL , BAG-1 , β-tubulin isotypes II , III and IV , τ protein , and detyrosinated α tubulin . Associations between selected parameters and survival were tested through univariate analyses , then completed with multivariate analyses and a bootstrap resampling technique . Results : In univariate analysis histologic grade , tumor size , number of involved nodes , estrogen and progesterone receptor status , p53 , Ki-67 , tubulin III , and τ protein were associated both with DFS and with OS . In multivariate analysis estrogen and progesterone receptors , tumor size , number of involved nodes , and Ki-67 protein were associated both with DFS and with OS , whereas τ protein levels were correlated with DFS and tubulin III and P53 were correlated with OS . No interaction was observed between Ki-67 and treatment allocation . Conclusions : We conclude that the expression in primary tumors of Ki-67 and p53 protein , as well as of the microtubule-related parameters τ protein and tubulin III , are independent prognostic factors in patients receiving adjuvant chemotherapy  for node-positive breast cancer but are not predictive of benefit from docetaxel-containing adjuvant chemotherapy . Clin Cancer Res ; 16(15 ) ; 3988–97 . © 2010 AACR
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 .