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 .
Benefit from anthracyclines in relation to biological profiles in early breast cancer
There are no vali date d predictors of benefit from anthracyclines . We compared cyclophosphamide , methotrexate , 5-fluorouracil ( CMF ) , and epirubicin in different sequences with CMF alone in a phase III trial on operable breast cancers . Outcomes were analyzed in relation to tumor biological profiles to identify potential predictors of the efficacy of different treatments/drug combinations . Patients with N− or 1–3N+ tumors , were r and omized to receive ( a ) epirubicin ( 4 cycles ) followed by CMF ( 4 cycles ) ; ( b ) CMF ( 4 cycles ) followed by epirubicin ( 4 cycles ) , or ( c ) CMF ( 6 cycles ) alone . Immunohistochemical assessment s of estrogen ( ER ) and progesterone ( PgR ) receptors , HER2 and Ki67 were available for 705 patients ( arm A/B/C : 276/269/160 ) . Prognostic and predictive relevance was analyzed by log-rank tests and Cox models . Ki67 > 20 % and absent/low expression of ER and PgR were associated with worsen disease-free ( DFS ) and overall survival ( OS ) . In patients with triple negative tumors ( ER− , PgR− , HER2− ) , epirubicin-containing regimens yielded better DFS ( HR 0.33 , 95 % CI 0.17–0.62 , P = 0.0007 ) and OS ( HR 0.24 , 95 % CI 0.10–0.57 , P = 0.001 ) compared with CMF alone , whereas no differences were found in patients with HER2-positive ( HER2 + , ER− , PgR− ) subtype . Treatment by subtype interaction ( HER2-positive vs. others ) was significant for DFS ( χ2 = 6.72 , P = 0.009 ) . In triple unfavorable ( ER− , PgR− , Ki67 > 20 % ) tumors , the use of epirubicin yielded better DFS ( HR 0.45,95 % CI 0.26–0.78 , P = 0.005 ) and OS ( HR 0.30 , 95 % CI 0.15–0.63 , P = 0.001 ) . Epirubicin-containing regimens seem to be superior to CMF alone in patients with highly proliferating , triple negative or triple unfavorable tumors
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 .