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 .
Adjuvant docetaxel for high-risk, node-negative breast cancer.
BACKGROUND A regimen of docetaxel , doxorubicin , and cyclophosphamide ( TAC ) is superior to a regimen of fluorouracil , doxorubicin , and cyclophosphamide ( FAC ) when used as adjuvant therapy in women with node-positive breast cancer . The value of taxanes in the treatment of node-negative disease has not been determined . METHODS We r and omly assigned 1060 women with axillary-node-negative breast cancer and at least one high-risk factor for recurrence ( according to the 1998 St. Gallen criteria ) to treatment with TAC or FAC every 3 weeks for six cycles after surgery . The primary end point was disease-free survival after at least 5 years of follow-up . Secondary end points included overall survival and toxicity . RESULTS At a median follow-up of 77 months , the proportion of patients alive and disease-free was higher among the 539 women in the TAC group ( 87.8 % ) than among the 521 women in the FAC group ( 81.8 % ) , representing a 32 % reduction in the risk of recurrence with TAC ( hazard ratio , 0.68 ; 95 % confidence interval [ CI ] , 0.49 to 0.93 ; P=0.01 by the log-rank test ) . This benefit was consistent , regardless of hormone-receptor status , menopausal status , or number of high-risk factors . The difference in survival rates  ( TAC , 95.2 % ; FAC , 93.5 % ) was not significant ( hazard ratio , 0.76 ; 95 % CI , 0.45 to 1.26 ) ; however , the number of events was small ( TAC , 26 ; FAC , 34 ) . Rates of grade 3 or 4 adverse events were 28.2 % with TAC and 17.0 % with FAC ( P<0.001 ) . Toxicity associated with TAC was diminished when primary prophylaxis with granulocyte colony-stimulating factor was provided . CONCLUSIONS As compared with adjuvant FAC , adjuvant TAC improved the rate of disease-free survival among women with high-risk , node-negative breast cancer . ( Funded by GEICAM and Sanofi-Aventis ; Clinical Trials.gov number , NCT00121992 . )
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 .