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 .
Adjuvant chemotherapy with sequential or concurrent anthracycline and docetaxel: Breast International Group 02-98 randomized trial.
BACKGROUND Docetaxel is more effective than doxorubicin for patients with advanced breast cancer . The Breast International Group 02 - 98 r and omized trial tested the effect of incorporating docetaxel into anthracycline-based adjuvant chemotherapy and compared sequential vs concurrent administration of doxorubicin and docetaxel . METHODS Patients with lymph node-positive breast cancer ( n = 2887 ) were r and omly assigned to one of four treatments : 1 ) sequential control ( four cycles of doxorubicin at 75 mg/m2 , followed by three cycles of cyclophosphamide , methotrexate , and 5-fluorouracil [ CMF ] ) ; 2 ) concurrent control ( four cycles of doxorubicin at 60 mg/m2 plus cyclophosphamide at 600 mg/m2 , followed by three cycles of CMF ) ; 3 ) sequential docetaxel ( three cycles of doxorubicin at 75 mg/m2 , followed by three cycles of docetaxel at 100 mg/m2 , followed by three cycles of CMF ) ; 4 ) concurrent docetaxel ( four cycles of doxorubicin at 50 mg/m2 plus docetaxel at 75 mg/m2 , followed by three cycles of CMF ) . The primary comparison evaluated the efficacy of including docetaxel regardless of schedule and was planned after 1215 disease-free survival ( DFS ) events ( ie , relapse , second primary cancer , or death from any cause ) . Docetaxel and control treatment groups were compared by log-rank tests , and hazard ratios ( HR ) of DFS events were calculated by Cox modeling . All statistical tests were two-sided . RESULTS Due to a lower-than-anticipated rate of relapse , this analysis was performed after 5 years with 732 events . Patients in control arms had a 5-year DFS of 73 % ( 95 % confidence interval [ CI ] = 70 % to 75 % ) . Docetaxel treatment result ed in an improvement in DFS of borderline statistical significance compared with control treatment ( HR = 0.86 , 95 % CI = 0.74 to 1.00 ; P = .05 ) . However , DFS in the sequential docetaxel arm was better than that in the concurrent docetaxel arm ( HR = 0.83 , 95 % CI = 0.69 to 1.00 ) and in the sequential control arm ( HR = 0.79 , 95 % CI = 0.64 to 0.98 ) . CONCLUSIONS Incorporating docetaxel into anthracycline-based therapy result ed in an improvement in DFS that was of borderline statistical significance . However , important differences may be related to doxorubicin and docetaxel scheduling , with sequential but not concurrent administration , appearing to produce better DFS than anthracycline-based chemotherapy
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 .