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 .
Final report of the phase I/II clinical trial of the E75 (nelipepimut-S) vaccine with booster inoculations to prevent disease recurrence in high-risk breast cancer patients.
BACKGROUND E75 ( nelipepimut-S ) is a human leukocyte antigen (HLA)-A2/A3-restricted immunogenic peptide derived from the HER2 protein . We have conducted phase I/II clinical trials vaccinating breast cancer patients with nelipepimut-S and granulocyte-macrophage colony-stimulating factor ( GM-CSF ) in the adjuvant setting to prevent disease recurrence . All patients have completed 60 months follow-up , and here , we report the final analyses . PATIENTS AND METHODS The studies were conducted as dose escalation/schedule optimization trials enrolling node-positive and high-risk node-negative patients with tumors expressing any degree of HER2 ( immunohistochemistry 1 - 3 + ) . HLA-A2/3 + patients were vaccinated ; others were followed prospect ively as controls .  Local and systemic toxicity was monitored . Clinical recurrences were documented , and disease-free survival ( DFS ) was analyzed by Kaplan-Meier curves ; groups were compared using log-rank tests . RESULTS Of 195 enrolled patients , 187 were assessable : 108 ( 57.8 % ) in the vaccinated group ( VG ) and 79 ( 42.2 % ) in the control group ( CG ) . The groups were well matched for clinicopathologic characteristics . Toxicities were minimal . Five-year DFS was 89.7 % in the VG versus 80.2 % in the CG ( P = 0.08 ) . Due to trial design , 65 % of patients received less than the optimal vaccine dose . Five-year DFS was 94.6 % in optimally dosed patients ( P = 0.05 versus the CG ) and 87.1 % in suboptimally dosed patients . A voluntary booster program was initiated , and among the 21 patients that were optimally boosted , there was only one recurrence ( DFS = 95.2 % ) . CONCLUSION The E75 vaccine is safe and appears to have clinical efficacy . A phase III trial evaluating the optimal dose and including booster inoculations has been initiated . CLINICAL TRIALS NCT00841399 , NCT00584789
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 .