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 epirubicin followed by cyclophosphamide, methotrexate and fluorouracil (CMF) vs CMF in early breast cancer: results with over 7 years median follow-up from the randomised phase III NEAT/BR9601 trials
Background : The National Epirubicin Adjuvant Trial ( NEAT ) and BR9601 trials tested the benefit of epirubicin when added to cyclophosphamide , methotrexate and 5-fluorouracil ( E-CMF ) compared with st and ard CMF in adjuvant chemotherapy for women with early breast cancer . This report details longer follow-up with interesting additional time-dependent analyses . Methods : National Epirubicin Adjuvant Trial used epirubicin ( E ) 3-weekly for four cycles followed by classical ( c ) CMF for four cycles ( E-CMF ) compared with cCMF for six cycles . BR9601 used E 3-weekly for four cycles followed by CMF 3-weekly for four cycles , compared with CMF 3-weekly for eight cycles . Results : In all , 2391 eligible patients were r and omised and with a median 7.4-year follow-up , E-CMF confirmed a significant benefit over CMF in both relapse-free survival ( RFS ) ( 78 % vs 71 % 5 years RFS , respectively , hazard ratio (HR)=0.75 ( 95 % CI : 0.65–0.86 ) , P<0.0001 ) and overall survival ( OS ) ( 84 % vs 78 % 5 years OS , respectively , HR=0.76 ( 95 % CI : 0.65–0.89 ) , P=0.0007 ) . Interaction of treatment effect and prognostic factors was demonstrated for duplication of chromosome 17 centromeric enumeration ( Ch17CEP ) as previously reported . Poor prognostic factors at diagnosis ( ER and PR negative and HER2 positive ) showed time-dependent annual hazard rates for RFS and OS . In univariate analysis , these factors demonstrated more favourable HRs for RFS after 5 years . Treatment effects also suggested a differential benefit for E-CMF within the first 5 years for poor prognosis tumours . Conclusion : Longer follow-up has confirmed E-CMF as significantly superior to CMF for all patients . Ch17CEP duplication was the only biomarker that demonstrated significant treatment interaction . St and ard poor prognostic factors at diagnosis were time-dependent , and after 5 years disease-free , poor prognosis patients demonstrated favourable HRs for survival
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 .