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 .
Fluorouracil, doxorubicin, and cyclophosphamide (FAC) versus FAC followed by weekly paclitaxel as adjuvant therapy for high-risk, node-negative breast cancer: results from the GEICAM/2003-02 study.
PURPOSE Adding taxanes to anthracycline-based adjuvant therapy improves survival outcomes of patients with node-positive breast cancer ( BC ) . Currently , however , most patients with BC are node negative at diagnosis . The only pure node-negative study ( Spanish Breast Cancer Research Group 9805 ) reported so far showed a docetaxel benefit but significant toxicity . Here we tested the efficacy and safety of weekly paclitaxel ( wP ) in node-negative patients , which is yet to be established . PATIENTS AND METHODS Patients with BC having T1-T3/N0 tumors and at least one high-risk factor for recurrence ( according to St. Gallen 1998 criteria ) were eligible . After primary surgery , 1,925 patients were r and omly assigned to receive fluorouracil , doxorubicin , and cyclophosphamide ( FAC ) × 6 or FAC × 4 followed by wP × 8 ( FAC-wP ) . The primary end point was disease-free survival ( DFS ) after a median follow-up of 5 years . Secondary end points included toxicity and overall survival . RESULTS After a median follow-up of 63.3 months , 93 % and 90.3 % of patients receiving FAC-wP or FAC regimens , respectively , remained disease free ( hazard ratio [ HR ] , 0.73 ; 95 % CI , 0.54 to 0.99 ; log-rank P = .04 ) . Thirty-one patients receiving FAC-wP versus 40 patients receiving FAC died ( one and seven from cardiovascular diseases , respectively ; HR , 0.79 ; 95 % CI , 0.49 to 1.26 ; log-rank P = .31 ) . The most relevant grade 3 and 4 adverse events in the FAC-wP versus the FAC arm were febrile neutropenia ( 2.7 % v 3.6 % ) , fatigue ( 7.9 % v 3.4 % ) , and sensory neuropathy ( 5.5 % v 0 % ) . CONCLUSION For patients with high-risk node-negative BC , the adjuvant FAC-wP regimen was associated with a small but significant improvement in DFS  compared with FAC therapy , in addition to manageable toxicity , especially regarding long-term cardiac effects
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 .