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 .
Phase III study of doxorubicin/cyclophosphamide with concomitant versus sequential docetaxel as adjuvant treatment in patients with human epidermal growth factor receptor 2-normal, node-positive breast cancer: BCIRG-005 trial.
PURPOSE Anthracyclines , taxanes , and alkylating agents are among the most active agents in treatment of adjuvant breast cancer ( BC ) , but the optimal schedule for their administration is unknown . We performed an adjuvant trial to compare the sequential regimen of doxorubicin with cyclophosphamide ( AC ) followed by docetaxel ( ie , AC > T ) with the combination regimen of TAC . PATIENTS AND METHODS Women with node-positive , human epidermal growth factor receptor 2-nonamplified , operable BC were stratified by number of axillary nodes and hormone receptor status and were r and omly assigned to adjuvant chemotherapy with six cycles of TAC ( 75/50/500 mg/m² every 3 weeks ) or four cycles of AC ( 60/600 mg/m² every 3 weeks ) followed by four doses of docetaxel at 100 mg/m² every 3 weeks ( AC > T ) . After completion of chemotherapy , radiation therapy was given as indicated , and patients with hormone receptor ( HR ) -positive disease received adjuvant hormonal therapy with tamoxifen and /or aromatase inhibitors . RESULTS In 30 months , 3,298 patients were enrolled ( n = 1,649 in each arm ) . The major baseline characteristics were well balanced between the groups . At a median follow-up of 65 months , estimated 5-year disease-free survival rates were 79 % in both groups ( log-rank P = .98 ; hazard ratio [ HR ] , 1.0 ; 95%CI , 0.86 to 1.16 ) , and 5-year overall survival rates for both arms were 88 % and 89 % , respectively ( log-rank P = .37 ; HR , 0.91 ; 95 % CI , 0.75 to 1.11 ) . TAC was associated with more febrile neutropenia and thrombocytopenia , and AC > T was associated with more sensory neuropathy , nail changes , and myalgia . The incidence of neutropenic infection was similar in both groups . CONCLUSION The sequential and combination regimens incorporating three drugs were equally effective but differed in toxicity profile
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 .