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 .
Randomized trial of cyclophosphamide, epirubicin, and fluorouracil chemotherapy compared with cyclophosphamide, methotrexate, and fluorouracil with node-positive breast cancer in Japan
Background To compare the cyclophosphamide , methotrexate , and fluorouracil ( CMF ) chemotherapy and the anthracycline-containing regimen cyclophosphamide , epirubicin , and fluorouracil ( CEF ) to evaluate the efficacy and safety of the latter . Methods A total of 294 patients with axillary node-positive primary breast cancer of STAGE I – IIIa were r and omly assigned to either CEF [ cyclophosphamide ( CPA ) 500 mg/m2 i.v . days 1 and 8 ; epirubicin ( EPI ) 60 mg/m2 i.v . day 1 ; and 5-fluorouracil ( 5-FU ) 500 mg/m2 i.v . days 1 and 8 ] or CMF [ CPA 500 mg/m2 i.v . days 1 and 8 ; methotrexate ( MTX ) 40 mg/m2 i.v . days 1 and 8 ; and 5-FU 500 mg/m2 i.v . days 1 and 8 ] . Both treatment regimens were comprised of six cycles at 4-week intervals . Tamoxifen ( TAM ) 20 mg/day was concomitantly given to estrogen receptor (ER)-positive patients and those with undetermined ER status for 2 years . Results The overall 5-year survival was 77.1 % for CEF and 71.4 % for CMF [ p = 0.24 ; hazard ratio 0.79 ( 95 % CI 0.50–1.24 ) ] , and the 5-year disease-free survival was 55.7 % for CEF and 48.9 % for CMF [ p = 0.15 ; hazard ratio 0.80 ( 95 % CI 0.57–1.12 ) ] . Although the log-rank test did not show a significant difference , both overall and disease-free survivals were higher for CEF according to the point estimates . Adverse drug reactions ( ADRs ) occurred more frequently in CEF . Conclusion Whereas CEF had a good trend compare with CMF , it could not be proven statistically significant . The principal cause of the failure seems to be insufficient power , that is , the dose intensity ( EPI : 60 mg/m2 ) set 10 years ago , when the trial began , was low , and the number of trial subjects was small because of the background of the times , which made the accumulation of cases extremely difficult . However , the trial should be considered to be meaningful , as it was the first , formally conducted controlled trial on chemotherapy in Japan
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 .