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 .
NEAT: National Epirubicin Adjuvant Trial – toxicity, delivered dose intensity and quality of life
The NEAT trial reported considerable benefit for ECMF ( epirubicin followed by cyclophosphamide , methotrexate and 5-fluorouracil ) of 28 % for relapse-free survival ( RFS ) and 30 % for overall survival ( OS ) , when compared with classical CMF in early breast cancer . To assess tolerability , toxicity , dose intensity and quality of life ( QoL ) analyses were undertaken . All 2021 eligible patients had common toxicity criteria ( CTC ) , delivered chemotherapy and supportive treatments details and long-term morbidities recorded . The QoL sub study used multiple vali date d measures . ECMF produced low CTC scores , although higher than CMF  for nausea , vomiting , alopecia , constipation , stomatitis ( P<0.001 ) , infection ( P=0.001 ) and fatigue ( P=0.03 ) . Supportive treatments required , however , were similar across r and omised treatments . On-treatment deaths were more common with CMF ( 13 ) than ECMF(5 ) . Optimal course-delivered dose intensity ( CDDI ⩾85 % ) was received more often by ECMF patients ( 83 vs 76 % : P=0.0002 ) , and was associated with better RFS ( P=0.0006 ) . QoL over 2 years was equivalent across treatments , despite minimally worse side effects for ECMF during treatment . ECMF benefit spanned all levels of toxicity , CDDI and QoL. There are no reported acute myeloid leukaemias or cardiac dysfunctions . ECMF is tolerable , deliverable , and significantly more effective than CMF , with no serious long-term toxicity or QoL detriment
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 .