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 .
Longer therapy, iatrogenic amenorrhea, and survival in early breast cancer.
BACKGROUND Chemotherapy regimens that combine anthracyclines and taxanes result in improved disease-free and overall survival among women with operable lymph-node-positive breast cancer . The effectiveness of concurrent versus sequential regimens is not known . METHODS We r and omly assigned 5351 patients with operable , node-positive , early-stage breast cancer to receive four cycles of doxorubicin and cyclophosphamide followed by four cycles of docetaxel ( sequential ACT ) ; four cycles of doxorubicin and docetaxel ( doxorubicin-docetaxel ) ; or four cycles of doxorubicin , cyclophosphamide , and docetaxel ( concurrent ACT ) . The primary aims were to examine whether concurrent ACT was more effective than sequential ACT and whether the doxorubicin-docetaxel regimen would be as effective as the concurrent-ACT regimen . The secondary aims were to assess toxic effects and to correlate amenorrhea with outcomes in premenopausal women . RESULTS At a median follow-up of 73 months , overall survival was improved in the sequential-ACT group ( 8-year overall survival , 83 % ) as compared with the doxorubicin-docetaxel group ( overall survival , 79 % ; hazard ratio for death , 0.83 ; P=0.03 ) and the concurrent-ACT group ( overall survival , 79 % ; hazard ratio , 0.86 ; P=0.09 ) . Disease-free survival was improved in the sequential-ACT group ( 8-year disease-free survival , 74 % ) as compared with the doxorubicin-docetaxel group ( disease-free survival , 69 % ; hazard ratio for recurrence , a second malignant condition , or death , 0.80 ; P=0.001 ) and the concurrent-ACT group ( disease-free survival , 69 % ; hazard ratio , 0.83 ; P=0.01 ) . The doxorubicin-docetaxel regimen showed noninferiority to the concurrent-ACT regimen for overall survival ( hazard ratio , 0.96 ; 95 % confidence interval , 0.82 to 1.14 ) . Overall survival was improved in patients with amenorrhea for 6 months or more across all treatment groups , independently of estrogen-receptor status . CONCLUSIONS Sequential ACT improved disease-free survival as compared with doxorubicin-docetaxel or concurrent ACT , and it improved overall survival as compared with doxorubicin-docetaxel .  Amenorrhea was associated with improved survival regardless of the treatment and estrogen-receptor status . ( Clinical Trials.gov number , NCT00003782 .
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 .