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 .
Ki67 Measured after Neoadjuvant Chemotherapy for Primary Breast Cancer
Purpose : The value of Ki67 measured on residual disease after neoadjuvant chemotherapy is not sufficiently described . Experimental Design : Participants of the GeparTrio study with primary breast cancer r and omly received neoadjuvant response-guided  [ 8 cycles  TAC ( docetaxel/doxorubicin/cyclophosphamide ) in responding and TAC-NX ( vinorelbine/capecitabine ) in nonresponding patients ] or  conventional ( 6 cycles TAC ) chemotherapy  according to interim response assessment . Ki-67 levels were central ly measured immunohistochemically after neoadjuvant treatment if tumor tissue was available . Here , we analyze 1,151 patients having a pathologic complete response ( pCR ; n , 484 ) , or residual disease with low ( 0–15 % ) , intermediate ( 15.1–35 % ) , or high ( 35.1–100 % ) posttreatment Ki67 levels in 488 , 77 , and 102 patients , respectively . Results : Patients with high posttreatment Ki67 levels showed higher risk for disease relapse ( P < 0.0001 ) and death ( P < 0.0001 ) compared with patients with low or intermediate Ki67 levels . Patients with low Ki67 levels showed a comparable outcome to patients with a pCR ( P = 0.211 for disease-free and P = 0.779 for overall survival ) . Posttreatment Ki67 levels provided more prognostic information than pretreatment Ki67 levels or changes of Ki67 from pre- to posttreatment . Information on pCR plus posttreatment Ki67 levels surmount the prognostic information of pCR alone in hormone – receptor-positive disease [ hazard ratios ( HR ) , 1.82–5.88 ] but not in hormone – receptor-negative disease ( HR : 0.61–1.73 ) . Patients with conventional and response-guided treatment did not show a different distribution of posttreatment Ki67 ( P = 0.965 ) . Conclusions : Posttreatment Ki67 levels provide prognostic information for patients with hormone – receptor-positive breast cancer and residual disease after neoadjuvant chemotherapy . Levels were not prognostic for outcome after response-guided chemotherapy . High posttreatment Ki67 indicates the need for innovative postneoadjuvant treatments . Clin Cancer Res ; 19(16 ) ; 4521–31 . © 2013 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 .