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 .
The potential risk of neoadjuvant chemotherapy in breast cancer patients—results from a prospective randomized trial of the Austrian Breast and Colorectal Cancer Study Group (ABCSG-07)
Purpose To evaluate the impact that pre- and postoperatively administered chemotherapy with cyclophosphamide , methotrexate and fluorouracil ( CMF ) and postoperative chemotherapy vs. postoperative chemotherapy alone have on long-term prognosis . Patients and Methods The ABCSG conducted a nationwide r and omized phase III trial in high-risk endocrine non-responsive breast cancer patients comparing pre- and postoperative chemotherapy containing CMF as preoperative treatment vs. postoperative chemotherapy alone between 1991 and 1999 . From 1996 the ABCSG-07 protocol was amended to also allow r and omization of high-risk endocrine-responsive patients . Of 423 eligible patients with high-risk primary breast cancer , 203 patients were r and omly assigned to preoperatively receive three cycles of CMF ( cyclophosphamide , methotrexate , fluorouracil ; 600/40/600 mg/m2 ) intravenously on day 1 and 8 , while 195 patients received postoperative chemotherapy alone . In both groups , three cycles of CMF were given initially , and another three cycles of CMF were administered in node-negative patients , whereas node-positive patients received three cycles of EC ( epirubicin , cyclophosphamide ; 70/600 mg/m2 ) . Results Overall response rate to preoperative chemotherapy with three cycles of CMF was 56.2 % ; complete pathological response was achieved in 12 patients ( 5.9 % ) . Recurrence-free survival was significantly better in patients receiving chemotherapy postoperatively ( HR 0.7 , 0.515–0.955 ; P = 0.024 ) . No survival difference was observed between the two therapy groups ( HR 0.800 , 0.563–1.136 ; P = 0.213 ) . Discussion Preoperative chemotherapy with CMF has to be considered as insufficient in high-risk breast cancer patients . Delayed surgery and anthracycline-based chemotherapy result in shorter recurrence-free survival but not overall survival
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 .