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 .
A multicenter phase III prospective randomized trial of high-dose epirubicin in combination with cyclophosphamide (EC) versus docetaxel followed by EC in node-positive breast cancer. GOIM (Gruppo Oncologico Italia Meridionale) 9902 study.
BACKGROUND The Gruppo Oncologico Italia Meridionale 9902 trial compared four cycles of high-dose epirubicin plus cyclophosphamide ( EC ) with four cycles of docetaxel ( Taxotere , D ) followed by four cycles of EC as adjuvant treatment of node-positive breast cancer . PATIENTS AND METHODS Patients were r and omly assigned to EC ( E 120 mg/m2 , C 600 mg/m2 , arm A ) for four cycles or four cycles of D ( 100 mg/m2 ) followed by four cycles of EC ( arm B ) , both regimens every 21 days . Hormone receptor-positive patients were given hormonal therapy for 5 years . Primary end point was 5-year disease-free survival ( DFS ) . Secondary objectives were overall survival ( OS ) and safety . RESULTS There were 750 patients enrolled . With a median follow-up of 64 months , 5-year DFS was 73.4 % in both arms , and 5-year OS was 89.5 % versus 90.7 % in arm A and B [ hazard ratio was 0.99 ( 95 % confidence interval for DFS 0.75 - 1.31 ; P = 0.95 ) ] , respectively . Grade 3 - 4 toxicity was more common in arm B. CONCLUSIONS This study did not show advantages from the addition of docetaxel to high-dose EC as adjuvant chemotherapy in node-positive breast cancer . The small sample size and low number of DFS events may have limited the ability to observe statistically significant difference between the two arms
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 .