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 .
tAnGo: a randomised phase III trial of gemcitabine in paclitaxel-containing, epirubicin/cyclophosphamide-based, adjuvant chemotherapy for early breast cancer: a prospective pulmonary, cardiac and hepatic function evaluation
tAnGo is a large r and omised trial assessing the addition of gemcitabine(G ) to paclitaxel(T ) , following epirubicin(E ) and cyclophosphamide(C ) in women with invasive higher risk early breast cancer . To assess the safety and tolerability of adding G , a detailed safety sub study was undertaken . A total of 135 patients had cardiac , pulmonary and hepatic function assessed at ( i ) r and omisation , ( ii ) mid-chemotherapy , ( iii ) immediately post-chemotherapy and ( iv ) 6 months post-chemotherapy .  Skin toxicity was assessed during radiotherapy . No differences were detected in FEV1 or FVC levels between treatment arms or time points . Diffusion capacity ( TLCO ) reduced during treatment ( P<0.0001 ) , with a significantly lower drop in EC-GT patients ( P=0.02 ) . Most of the reduction occurred during EC and recovered by 6-months post treatment . There was no difference in cardiac function between treatment arms . Only 11 patients had echocardiography/MUGA results  change from normal to abnormal during treatment , with only five having LVEF<50 % . Transient transaminitis occurred in both treatment arms with significantly more in EC-GT patients post-chemotherapy ( AST P=0.03 , ALT P=0.003 ) , although the majority was low grade . There was no correlation between transaminitis and other toxicities . Both treatment regimens reported temporary reductions in pulmonary functions and transient transaminitis levels . Despite these being greater with EC-GT , both regimens appear well tolerated
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 .