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 .
Epirubicin and cyclophosphamide, methotrexate, and fluorouracil as adjuvant therapy for early breast cancer.
BACKGROUND The National Epirubicin Adjuvant Trial ( NEAT ) and the BR9601 trial examined the efficacy of anthracyclines in the adjuvant treatment of early breast cancer . METHODS In NEAT , we compared four cycles of epirubicin followed by four cycles of cyclophosphamide , methotrexate , and fluorouracil ( CMF ) with six cycles of CMF alone . In the BR9601 trial , we compared four cycles of epirubicin followed by four cycles of CMF , with eight cycles of CMF alone every 3 weeks . The primary end points were relapse-free and overall survival . The secondary end points were adverse effects , dose intensity , and quality of life . RESULTS The two trials included 2391 women with early breast cancer ; the median follow-up was 48 months . Relapse-free and overall survival rates were significantly higher in the epirubicin-CMF groups than in the CMF-alone groups ( 2-year relapse-free survival , 91 % vs. 85 % ; 5-year relapse-free survival , 76 % vs. 69 % ; 2-year overall survival , 95 % vs. 92 % ; 5-year overall survival , 82 % vs. 75 % ; P<0.001 by the log-rank test for all comparisons ) . Hazard ratios for relapse ( or death without relapse ) ( 0.69 ; 95 % confidence interval [ CI ] , 0.58 to 0.82 ; P<0.001 ) and death from any cause ( 0.67 ; 95 % CI , 0.55 to 0.82 ; P<0.001 ) favored epirubicin plus CMF over CMF alone . Independent prognostic factors were nodal status , tumor grade , tumor size , and estrogen-receptor status ( P<0.001 for all four factors ) and the presence or absence of vascular or lymphatic invasion ( P=0.01 ) . These factors did not significantly interact with the effect of epirubicin plus CMF . The overall incidence of adverse effects was significantly higher with epirubicin plus CMF than with CMF alone but did not significantly affect the delivered-dose intensity or the quality of life . CONCLUSIONS Epirubicin plus CMF is superior to CMF alone as adjuvant treatment for early breast cancer . ( Clinical Trials.gov number , NCT00003577 [ Clinical Trials.gov ] . )
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 .