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 .
Overall survival benefit for sequential doxorubicin-docetaxel compared with concurrent doxorubicin and docetaxel in node-positive breast cancer--8-year results of the Breast International Group 02-98 phase III trial.
Background In women with node-positive breast cancer , the Breast International Group ( BIG ) 02 - 98 tested the incorporation of docetaxel ( Taxotere ) into doxorubicin (Adriamycin)-based chemotherapy , and compared sequential and concurrent docetaxel . At 5 years , there was a trend for improved disease-free survival ( DFS ) with docetaxel . We present results at 8-year median follow-up and exploratory analyses within biologically defined subtypes . Methods Patients were r and omly assigned to one of four treatments : ( i ) sequential control : doxorubicin ( A ) ( 75 mg/m(2 ) ) × 4 →classical cyclophosphamide , methotrexate , 5-fluorouracil ( CMF ) ; ( ii ) concurrent control : doxorubicin , cyclophosphamide (AC)(60/600 mg/m(2 ) ) × 4 →CMF ; ( iii ) sequential docetaxel : A ( 75 mg/m(2 ) ) × 3 → docetaxel ( T ) ( 100 mg/m(2 ) ) × 3 → CMF and ( iv ) concurrent docetaxel : AT(50/75 mg/m(2 ) ) × 4 →CMF . The primary comparison evaluated  docetaxel efficacy regardless of the schedule . Exploratory analyses were undertaken within biologically defined subtypes . Results Two thous and eight hundred and eighty-seven patients were enrolled . After 93.4 months of median follow-up , there were 916 DFS events . For the primary comparison , there was no significant improvement in DFS  from docetaxel [ hazard ratio ( HR ) = 0.91 , 95 % confidence interval ( CI ) = 0.80 - 1.05 , P = 0.187 ] . In secondary comparisons , sequential docetaxel  significantly improved DFS compared with sequential control ( HR = 0.81 , 95 % CI = 0.67 - 0.99 , P = 0.036 ) , and significantly improved DFS ( HR = 0.84 , 95 % CI = 0.72 - 0.99 , P = 0.035 ) and overall survival ( OS ) ( HR = 0.79 , 95 % CI = 0.65 - 0.98 , P = 0.028 ) compared with concurrent doxorubicin-docetaxel . Luminal-A disease had the best prognosis . HRs favored addition of sequential docetaxel in all subtypes , except luminal-A ; but this observation was not statistically supported because of limited numbers . Conclusion With further follow-up , the sequential docetaxel schedule result ed in significantly better OS than concurrent doxorubicin-docetaxel , and continued to show better  DFS than sequential doxorubicin-based control
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 .