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 .
Intensive dose-dense compared with conventionally scheduled preoperative chemotherapy for high-risk primary breast cancer.
PURPOSE To compare preoperative intense dose-dense ( IDD ) chemotherapy with conventionally scheduled preoperative chemotherapy in high-risk primary breast cancer ( BC ) . PATIENTS AND METHODS In this r and omized phase III trial a total of 668 eligible primary BC patients stratified for tumors > or = 3 cm ( n = 567 ) or inflammatory BC ( n = 101 ) were r and omly assigned to receive concurrent preoperative epirubicin/paclitaxel every 3 weeks or dose-dense and dose-escalated sequential epirubicin followed by paclitaxel every 2 weeks . All patients received three cycles of cyclophosphamide , methotrexate , and fluorouracil chemotherapy after surgery . RESULTS IDD treatment significantly improved pathologic complete response rate ( 18 % v 10 % ; odds ratio [ OR ] 1.89 ; P = .008 ) , disease-free survival ( DFS ; hazard ratio [ HR ] , 0.71 ; P = .011 ) , and overall survival ( OS ; HR , 0.83 ; P = .041 ) compared to epirubicin/paclitaxel .  Patients with inflammatory BC had a particularly poor prognosis and did not appear to benefit from IDD therapy in this trial ( DFS HR , 1.10 ; P = .739 ; OS HR , 1.25 ; P = .544 ) . In contrast , patients with noninflammatory BC significantly benefited from IDD treatment ( DFS HR , 0.65 , P = .005 ; OS HR , 0.77 , P = .013 ) . Treatment effects in multivariate analysis were significant for noninflammatory BC ( DFS HR , 0.65 , P = .015 ; OS HR , 0.79 , P = .034 ) , but not for all patients ( DFS HR , 0.76 ; P = .088 ; OS HR , 0.82 ; P = .059 ) . IDD therapy was associated with significantly more nonhematologic toxicities , anemia , and thrombocytopenia , but with similar neutropenia and infection rates . CONCLUSION Our results support the efficacy and short-term safety of IDD as preoperative chemotherapy . IDD was less well tolerated compared to st and ard treatment , but improved clinical outcomes in patients with noninflammatory high-risk primary BC
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 .