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 .
Randomized phase 3 trial of fluorouracil, epirubicin, and cyclophosphamide alone or followed by Paclitaxel for early breast cancer.
BACKGROUND Taxanes are among the most active drugs for the treatment of metastatic breast cancer , and , as a consequence , they have also been studied in the adjuvant setting . METHODS After breast cancer surgery , women with lymph node-positive disease were r and omly assigned to treatment with fluorouracil , epirubicin , and cyclophosphamide ( FEC ) or with FEC followed by weekly paclitaxel ( FEC-P ) . The primary endpoint of study -5-year disease-free survival (DFS)-was assessed by Kaplan-Meier analysis . Secondary endpoints included overall survival and analysis of the prognostic and predictive value of clinical and molecular ( hormone receptors by immunohistochemistry and HER2 by fluorescence in situ hybridization ) markers . Associations and interactions were assessed with a multivariable Cox proportional hazards model for DFS for the following covariates : age , menopausal status , tumor size , lymph node status , type of chemotherapy , tumor size , positive lymph nodes , HER2 status , and hormone receptor status . All statistical tests were two-sided . RESULTS Among the 1246 eligible patients , estimated rates of DFS at 5 years were 78.5 % in the FEC-P arm and 72.1 % in the FEC arm ( difference = 6.4 % , 95 % confidence interval [ CI ] = 1.6 % to 11.2 % ; P = .006 ) . FEC-P treatment was associated with a 23 % reduction in the risk of relapse compared with FEC treatment ( 146 relapses in the 614 patients in the FEC-P arm vs 193 relapses in the 632 patients in the FEC arm , hazard ratio [ HR ] = 0.77 , 95 % CI = 0.62 to 0.95 ; P = .022 ) and a 22 % reduction in the risk of death ( 73 and 95 deaths , respectively , HR = 0.78 , 95 % CI = 0.57 to 1.06 ; P = .110 ) . Among the 928 patients for whom tumor sample s were central ly analyzed , type of chemotherapy ( FEC vs FEC-P ) ( P = .017 ) , number of involved axillary lymph nodes ( P < .001 ) , tumor size ( P = .020 ) , hormone receptor status ( P = .004 ) , and HER2 status ( P = .006 ) were all associated with DFS . We found no statistically significant interaction between HER2 status and paclitaxel treatment or between hormone receptor status and paclitaxel treatment . CONCLUSIONS Among patients with operable breast cancer , FEC-P treatment statistically significantly reduced the risk of relapse compared with FEC as adjuvant therapy
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 .