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 .
Effect of addition of adjuvant paclitaxel on radiotherapy delivery and locoregional control of node-positive breast cancer: cancer and leukemia group B 9344.
PURPOSE We compared radiotherapy ( RT ) delivery and locoregional control in patients with node-positive breast cancer r and omly assigned on Cancer and Leukemia Group B 9344 to receive adjuvant doxorubicin/cyclophosphamide ( AC )  with patients assigned to receive AC followed by paclitaxel ( AC+T ) . METHODS Eligible patients were r and omly assigned to receive adjuvant AC versus AC+T chemotherapy .  RT was required if breast-conserving surgery was performed but was elective after mastectomy . Information about RT delivery was retrospectively collected . Cumulative incidence of locoregional recurrence ( LRR ) , use of elective RT , and RT delivery were compared between treatment arms . RESULTS For patients treated with breast-conserving surgery and RT , the 5-year cumulative incidence of isolated LRR was 9.7 % in the AC arm and 3.7 % in the AC+T arm ( P = .04 ) and of LRR as any component of failure was 12.9 % versus 6.1 % , respectively ( P = .04 ) . Although LRR rates in patients who did not receive postmastectomy RT were lower in the AC+T arm , the difference was not statistically significant . Despite the lack of protocol guidelines , RT use did not differ between arms , nor did RT dose , treatment interruption , or completion . CONCLUSION Despite the delay to RT during additional chemotherapy , adjuvant AC+T afforded better local control than AC alone in patients treated with breast-conserving therapy . Addition of paclitaxel did not adversely affect delivery or ability to tolerate RT , as indicated by similar rates of completion of timely , full-dose RT between 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 .