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 .
Responsiveness of Intrinsic Subtypes to Adjuvant Anthracycline Substitution in the NCIC.CTG MA.5 Randomized Trial
Purpose : Recent studies suggest that intrinsic breast cancer subtypes may differ in their responsiveness to specific chemotherapy regimens . We examined this hypothesis on NCIC.CTG MA.5 , a clinical trial r and omizing premenopausal women with node-positive breast cancer to adjuvant CMF ( cyclophosphamide-methotrexate-fluorouracil ) versus CEF ( cyclophosphamide-epirubicin-fluorouracil ) chemotherapy . Experimental Design : Intrinsic subtype was determined for 476 tumors using the quantitative reverse transcriptase PCR PAM50 gene expression test . Luminal A , luminal B , HER2-enriched ( HER2-E ) , and basal-like subtypes were correlated with relapse-free survival ( RFS ) and overall survival ( OS ) , estimated using Kaplan – Meier plots and log-rank testing . Multivariable Cox regression analyses determined significance of interaction between treatment and intrinsic subtypes . Results : Intrinsic subtypes were associated with RFS ( P = 0.0005 ) and OS ( P < 0.0001 ) on the combined cohort . The HER2-E showed the greatest benefit from CEF versus CMF , with absolute 5-year RFS and OS differences exceeding 20 % , whereas there was a less than 2 % difference for non – HER2-E tumors ( interaction test P = 0.03 for RFS and 0.03 for OS ) . Within clinical ly defined Her2 + tumors , 79 % ( 72 of 91 ) were classified as the HER2-E subtype by gene expression and this subset was strongly associated with better response to CEF versus CMF ( 62 % vs. 22 % , P = 0.0006 ) . There was no significant difference in benefit between CEF and CMF in basal-like tumors [ n = 94 ; HR , 1.1 ; 95 % confidence interval ( CI ) , 0.6–2.1 for RFS and HR , 1.3 ; 95 % CI , 0.7–2.5 for OS ] . Conclusion : HER2-E strongly predicted anthracycline sensitivity . The chemotherapy-sensitive basal-like tumors showed no added benefit for CEF over CMF , suggesting that nonanthracycline regimens may be adequate in this subtype although further investigation is required . Clin Cancer Res ; 18(8 ) ; 2402–12 . © 2012 AACR
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 .