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 .
Adjuvant chemotherapy in older women with early-stage breast cancer.
BACKGROUND Older women with breast cancer are underrepresented in clinical trials , and data on the effects of adjuvant chemotherapy in such patients are scant . We tested for the noninferiority of capecitabine as compared with st and ard chemotherapy in women with breast cancer who were 65 years of age or older . METHODS We r and omly assigned patients with stage I , II , IIIA , or IIIB breast cancer to st and ard chemotherapy ( either cyclophosphamide , methotrexate , and fluorouracil or cyclophosphamide plus doxorubicin ) or capecitabine . Endocrine therapy was recommended after chemotherapy in patients with hormone-receptor-positive tumors . A Bayesian statistical design was used with a range in sample size from 600 to 1800 patients . The primary end point was relapse-free survival . RESULTS When the 600th patient was enrolled , the probability that , with longer follow-up , capecitabine therapy was highly likely to be inferior to st and ard chemotherapy met a prescribed level , and enrollment was discontinued . After an additional year of follow-up , the hazard ratio for disease recurrence or death in the capecitabine group was 2.09 ( 95 % confidence interval , 1.38 to 3.17 ; P<0.001 ) . Patients who were r and omly assigned to capecitabine were twice as likely to have a relapse and almost twice as likely to die as patients who were r and omly assigned to st and ard chemotherapy ( P=0.02 ) . At 3 years , the rate of relapse-free survival was 68 % in the capecitabine group versus 85 % in the st and ard-chemotherapy group , and the overall survival rate was 86 % versus 91 % . Two patients in the capecitabine group died of treatment-related complications ; as compared with patients receiving capecitabine , twice as many patients receiving st and ard chemotherapy had moderate-to-severe toxic effects ( 64 % vs. 33 % ) . CONCLUSIONS St and ard adjuvant chemotherapy is superior to capecitabine in patients with early-stage breast cancer who are 65 years of age or older . ( Clinical Trials.gov number , NCT00024102 .
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 .