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 .
Cyclophosphamide, epirubicin, and Fluorouracil versus dose-dense epirubicin and cyclophosphamide followed by Paclitaxel versus Doxorubicin and cyclophosphamide followed by Paclitaxel in node-positive or high-risk node-negative breast cancer.
PURPOSE Cyclophosphamide , epirubicin , and fluorouracil ( CEF ) and doxorubicin and cyclophosphamide ( AC ) followed by paclitaxel ( T ) are commonly used adjuvant regimens in women with early breast cancer . In a previous trial in women with locally advanced breast cancer , 3 months of high-dose epirubicin and cyclophosphamide ( EC ) administered every 2 weeks ( dose-dense ) was equivalent to 6 months of CEF . We hypothesized that 3 months of paclitaxel after dose-dense EC ( EC/T ) would be superior to CEF or AC/T. METHODS After lumpectomy or mastectomy , women 60 years of age or younger with axillary node-positive or high-risk node-negative breast cancer were r and omly assigned to receive CEF , EC/T , or AC/T for 6 months . This article reports the interim analysis for recurrence-free survival ( RFS ) , which was planned after 227 recurrences . Results A total of 2,104 patients were enrolled . The median follow-up is 30.4 months . Hazard ratios for recurrence are as follows : AC/T versus CEF , 1.49 ( 95 % CI , 1.12 to 1.99 ) , P = .005 ; AC/T versus EC/T , 1.68 ( 95 % CI , 1.25 to 2.27 ) , P = .0006 ; and EC/T versus CEF , 0.89 ( 95 % CI , 0.64 to 1.22 ) , P = .46 . Three-year RFS rates for CEF , EC/T , and AC/T are 90.1 % , 89.5 % , and 85.0 % , respectively . There was more febrile neutropenia with CEF ( 22.3 % ) and EC/T ( 16.4 % ) compared with AC/T ( 4.8 % ) , but more neuropathy with the last two regimens . CONCLUSION Three-weekly AC/T is significantly inferior to CEF or EC/T in terms of RFS . It is too early to detect any difference between CEF and dose-dense
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 .