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 .
A randomized phase II trial of doxorubicin plus pemetrexed followed by docetaxel versus doxorubicin plus cyclophosphamide followed by docetaxel as neoadjuvant treatment of early breast cancer.
BACKGROUND Neoadjuvant systemic therapy ( NST ) before surgery is a st and ard option for patients with early breast cancer ( EBC ) that allows in vivo chemosensitivity testing . Given the promising activity of pemetrexed plus doxorubicin in metastatic breast cancer , it was reasonable to evaluate the utility of this combination as part of an NST regimen in EBC . PATIENTS AND METHODS Patients with untreated operable T2-T4a-c N0 - 2 M0 breast cancer were r and omly assigned to receive either four cycles of pemetrexed 500 mg/m(2 ) plus doxorubicin 60 mg/m(2 ) every 3 weeks ( q3w ) followed by four cycles of docetaxel 100 mg/m(2 ) q3w ( AP-D ) or four cycles of doxorubicin 60 mg/m(2 ) plus cyclophosphamide 600 mg/m(2 ) q3w followed by four cycles of docetaxel 100 mg/m(2 ) q3w ( AC-D ) . Surgery was carried out within 2 months after last chemotherapy . Primary end point was pathological complete response ( pCR ) rate in the breast . Secondary end points included clinical response rate , rate of histologically negative axillary lymph nodes , toxicity , and disease-free survival . RESULTS From September 2005 to August 2007 , 257 patients were r and omly allocated to 17 sites . Median age was 48 and 49 years for AP-D and AC-D , respectively . Overall pCR rates were 16.5 % for AP-D and 20.2 % for AC-D. With AP-D , pCR rate was 17.8 % for hormone receptor (HR)-negative patients and 15.9 % for HR-positive patients . With AC-D , pCR rates were 42.9 % and 7.8 % for HR-negative and HR-positive patients , respectively . Clinical response rates were 59.5 % in the AP-D group and 68.1 % in the AC-D group . The rate of histologically negative axillary lymph nodes was 53 % in both groups . Both treatments were well tolerated . Median disease-free survival is currently not mature . CONCLUSIONS AP-D and AC-D are well tolerated and active as NST in EBC . Of note , AC-D had a higher pCR rate in HR-negative tumors , whereas AP-D had more activity if HRs were expressed
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 .