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 .
A randomized phase-III trial of docetaxel/capecitabine versus doxorubicin/cyclophosphamide as primary chemotherapy for patients with stage II/III breast cancer
We aim ed to determine the efficacies of a non-anthracycline-containing regimen , docetaxel/capecitabine ( TX ) , in comparison with an anthracycline-containing regimen , doxorubicin/cyclophosphamide ( AC ) , as primary chemotherapy for node-positive early stage breast cancer . In this phase-III single center r and omized study , we r and omized 209 women with axillary node positive , stage II/III breast cancer to receive four cycles of either TX or AC followed by surgery and cross-over to the other treatment as an adjuvant therapy . The primary endpoint was tumor pathologic complete response ( pCR ) . Clinical response rates , toxicity profiles , disease free survival ( DFS ) , and overall survival were secondary objectives . In total , 204 patients had clinical and radiological evaluation of response , and underwent surgery . Compared with AC , TX increased pCR in primary tumors ( 21 % vs. 10 % , respectively , P = 0.024 ) and clinical response ( 84 % vs. 65 % , P = 0.003 ) . TX was associated with less nausea and vomiting , but more stomatitis , diarrhea , myalgia , and skin/nail changes than AC . With a median follow-up of 37 months , there was no significant difference in DFS by treatment groups ( P = 0.932 ) . Fewer patients developed recurrence who achieved pCR in lymph node ( LN ) ( P = 0.025 ; hazard ratio , 0.189 ; 95 % CI , 0.044–0.815 ) in the multivariate analysis . TX showed superior efficacies to AC with increased pathologic and clinical complete response rates . Although these findings did not translate into a gain in DFS , the patients who achieved pCR in LN developed significantly less recurrence
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 .