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 capecitabine, docetaxel, cyclophosphamide, and epirubicin for early breast cancer: final analysis of the randomized FinXX trial.
PURPOSE Capecitabine is an active agent in the treatment of breast cancer . It is not known whether integration of capecitabine into an adjuvant regimen that contains a taxane , an anthracycline , and cyclophosphamide improves outcome in early breast cancer . PATIENTS AND METHODS Women with axillary node-positive or high-risk node-negative breast cancer were r and omly assigned to receive either three cycles of docetaxel and capecitabine ( TX ) followed by three cycles of cyclophosphamide , epirubicin , and capecitabine ( CEX ; n = 753 ) or three cycles of docetaxel ( T ) followed by three cycles of cyclophosphamide , epirubicin , and fluorouracil ( CEF ; n = 747 ) . The primary end point was recurrence-free survival ( RFS ) . RESULTS During a median follow-up time of 59 months , 214 RFS events occurred ( local or distant recurrences or deaths ; TX/CEX , n = 96 ; T/CEF , n = 118 ) . RFS was not significantly different between the groups ( hazard ratio [ HR ] , 0.79 ; 95 % CI , 0.60 to 1.04 ; P = .087 ; 5-year RFS , 86.6 % for TX/CEX v 84.1 % for T/CEF ) . Fifty-six patients assigned to TX/CEX died during the follow-up compared with 75 of patients assigned to T/CEF ( HR , 0.73 ; 95 % CI , 0.52 to 1.04 ; P = .080 ) . In exploratory analyses , TX/CEX improved breast cancer-specific survival ( HR , 0.64 ; 95 % CI , 0.44 to 0.95 ; P = .027 ) and RFS in women with triple-negative disease and in women who had more than three metastatic axillary lymph nodes at the time of diagnosis . We detected little severe late toxicity . CONCLUSION Integration of capecitabine into a regimen that contains docetaxel , epirubicin , and cyclophosphamide did not improve RFS significantly compared with a similar regimen without capecitabine
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 .