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 .
FEC versus sequential docetaxel followed by epirubicin/cyclophosphamide as adjuvant chemotherapy in women with axillary node-positive early breast cancer: a randomized study of the Hellenic Oncology Research Group (HORG)
A r and omized multicenter phase III study was conducted to compare the sequential docetaxel followed by epirubicin/cyclophosphamide combination with that of FEC regimen as adjuvant chemotherapy in women with axillary node-positive early breast cancer . Seven hundred and fifty-six women with axillary lymph node-positive breast cancer were r and omized to receive either 4 cycles of docetaxel ( 100 mg/m2 ) followed by 4 cycles of epirubicin ( 75 mg/m2 ) plus cyclophosphamide ( 700 mg/m2 ) ( experimental arm ) or 6 cycles of FEC ( epirubicin 75 mg/m2 , cyclophosphamide 700 mg/m2 , and 5-fluorouracil 700 mg/m2 ; control arm ) . All regimes were administered every 3 weeks . The primary end point was five-year disease-free survival ( DFS ) . After a median follow-up period of 5 years , 233 ( 30.8 % ) relapses had occurred ( 108 and 125 in the experimental and control arms , respectively ; P = 0.181 ) . The five-year DFS was 72.6 % ( 95 % CI 63.8–81.3 % ) and 67.2 % ( 95 % CI 58.0–76.4 % ) for women r and omized in the experimental and control arms , respectively ( P = 0.041 ; log rank test ) . There was no difference in the overall survival between the two arms ( 83.8 and 81.4 % in the experimental and control arms , respectively ; P = 0.533 ) . The experimental arm was associated with increased neutropenia requiring administration of granulocyte colony-stimulating factor in 90.5 % of the patients as compared with 74.1 % in the control arm ( P = 0.0001 ) . The sequential docetaxel followed by epirubicin/cyclophosphamide adjuvant chemotherapy regimen result ed in improved five-year DFS in women with axillary node-positive early breast cancer at the expense of increased but manageable myelotoxicity
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 .