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 .
Sequential docetaxel as adjuvant chemotherapy for early breast cancer (TACT): an open-label, phase III, randomised controlled trial
Summary Background Incorporation of a taxane as adjuvant treatment for early breast cancer offers potential for further improvement of anthracycline-based treatment . The UK TACT study ( CRUK01/001 ) investigated whether sequential docetaxel after anthracycline chemotherapy would improve patient outcome compared with st and ard chemotherapy of similar duration . Methods In this multicentre , open-label , phase III , r and omised controlled trial , 4162 women ( aged > 18 years ) with node-positive or high-risk node-negative operable early breast cancer were r and omly assigned by computer-generated permuted block r and omisation to receive FEC ( fluorouracil 600 mg/m2 , epirubicin 60 mg/m2 , cyclophosphamide 600 mg/m2 at 3-weekly intervals ) for four cycles followed by docetaxel ( 100 mg/m2 at 3-weekly intervals ) for four cycles ( n=2073 ) or control ( n=2089 ) . For the control regimen , centres chose either FEC for eight cycles ( n=1265 ) or epirubicin ( 100 mg/m2 at 3-weekly intervals ) for four cycles followed by CMF ( cyclophosphamide 600 mg/m2 , methotrexate 40 mg/m2 , and fluorouracil 600 mg/m2 at 4-weekly intervals ) for four cycles ( n=824 ) . The primary endpoint was disease-free survival . Analysis was by intention to treat ( ITT ) . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N79718493 . Findings All r and omised patients were included in the ITT population . With a median follow-up of 62 months , disease-free survival events were seen in 517 of 2073 patients in the experimental group compared with 539 of 2089 controls ( hazard ratio [ HR ] 0·95 , 95 % CI 0·85–1·08 ; p=0·44 ) . 75·6 % ( 95 % CI 73·7–77·5 ) of patients in the experimental group and 74·3 % ( 72·3–76·2 ) of controls were alive and disease-free at 5 years . The proportion of patients who reported any acute grade 3 or 4 adverse event was significantly greater in the experimental group than in the control group ( p<0·0001 ) ; the most frequent events were neutropenia ( 937 events vs 797 events ) , leucopenia ( 507 vs 362 ) , and lethargy ( 456 vs 272 ) . Interpretation This study did not show any overall gain from the addition of docetaxel to st and ard anthracycline chemotherapy . Exploration of predictive biomarker-defined subgroups might have the potential to better target the use of taxane-based therapy . Funding Cancer Research UK ( CRUK 01/001 ) , Sanofi-Aventis , Pfizer , and Roche
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 .