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 .
Molecular predictors of efficacy of adjuvant weekly paclitaxel in early breast cancer
Treatment with fluororacil , epirubicin , and cyclophosphamide followed by weekly paclitaxel ( FEC-P ) yielded superior disease-free survival than FEC in the adjuvant breast cancer trial GEICAM 9906 . We evaluate molecular subtypes predictive of prognosis and  paclitaxel response in this trial . Two molecular subtype classifications based on conventional immunohistochemical and fluorescent in situ hybridization determinations were used : # 1 : Four groups segregated according to the combination of hormone receptor ( HR ) and HER2 status ; # 2 : Intrinsic subtype classification ( Triple Negative ( TN ) , HER2 , Luminal B and Luminal A ) . Results : Both subtype classifications yielded prognostic and predictive information . HR + /HER2− patients ( and Luminal A patients ) had a significantly better outcome than the other subgroups of patients . The superiority of FEC-P over FEC  was clearly more marked in HR−/HER2− patients ( TN patients ) , particularly in the subset with basal phenotype ( TN and either EGFR+ or cytokeratins 5/6 + ) . The Luminal A subtype also achieved a significant benefit with FEC-P.  The molecular-defined subgroup of TN was clearly predictive of better response to treatment with FEC-P.  Luminal A patients had the best prognosis and also have a better outcome with weekly paclitaxel
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 .