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 .
Prognostic and predictive value of TP53 mutations in node-positive breast cancer patients treated with anthracycline- or anthracycline/taxane-based adjuvant therapy: results from the BIG 02-98 phase III trial
Introduction Pre- clinical data suggest p53-dependent anthracycline-induced apoptosis and p53-independent taxane activity . However , dedicated clinical research has not defined a predictive role for TP53 gene mutations . The aim of the current study was to retrospectively explore the prognosis and predictive values of TP53 somatic mutations in the BIG 02 - 98 r and omized phase III trial in which women with node-positive breast cancer were treated with adjuvant doxorubicin-based chemotherapy with or without docetaxel . Methods The prognostic and predictive values of TP53 were analyzed in tumor sample s by gene sequencing within exons 5 to 8 . Patients were classified according to  p53 protein status predicted from TP53 gene sequence , as wild-type ( no TP53 variation or TP53 variations which are predicted not to modify p53 protein sequence ) or mutant ( p53 nonsynonymous mutations ) . Mutations were subcategorized according to missense or truncating mutations . Survival analyses were performed using the Kaplan-Meier method and log-rank test . Cox-regression analysis was used to identify independent predictors of outcome . Results TP53 gene status was determined for 18 % ( 520 of 2887 ) of the women enrolled in BIG 02 - 98 .  TP53 gene variations were found in 17 % ( 90 of 520 ) . Nonsynonymous p53 mutations , found in 16.3 % ( 85 of 520 ) , were associated with older age , ductal morphology , higher grade and hormone-receptor negativity . Of the nonsynonymous mutations , 12.3 % ( 64 of 520 ) were missense and 3.6 % were truncating ( 19 of 520 ) . Only truncating mutations showed significant independent prognostic value , with an increased recurrence risk compared to patients with non-modified p53 protein ( hazard ratio = 3.21 , 95 % confidence interval = 1.740 to 5.935 , P = 0.0002 ) . p53 status had no significant predictive value for response to docetaxel . Conclusions p53 truncating mutations were uncommon but associated with poor prognosis . No significant predictive role for p53 status was detected . Trial registration Clinical Trials.gov
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 .