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 .
Phase III trial evaluating the addition of paclitaxel to doxorubicin followed by cyclophosphamide, methotrexate, and fluorouracil, as adjuvant or primary systemic therapy: European Cooperative Trial in Operable Breast Cancer.
PURPOSE To evaluate the addition of paclitaxel to an anthracycline-based adjuvant regimen and to compare this combination with the same regimen given as primary systemic ( neoadjuvant ) therapy . PATIENTS AND METHODS A total of 1,355 women with operable breast cancer were r and omly assigned to one of three treatments : surgery followed by adjuvant doxorubicin ( 75 mg/m(2 ) ) followed by cyclophosphamide , methotrexate , and fluorouracil ( CMF ; arm A ) ; surgery followed by adjuvant paclitaxel ( 200 mg/m(2 ) ) plus doxorubicin ( 60 mg/m(2 ) ) , followed by CMF ( arm B ) ; or paclitaxel ( 200 mg/m(2 ) ) plus doxorubicin ( 60 mg/m(2 ) ) followed by CMF followed by surgery ( arm C ) . The two co primary objectives were to assess the effects on relapse-free survival ( RFS ) of the addition of paclitaxel to postoperative chemotherapy ( arm B v arm A ) and primary chemotherapy versus adjuvant chemotherapy ( arm B v arm C ) . RESULTS Doxorubicin plus paclitaxel followed by CMF was well-tolerated as adjuvant or as primary chemotherapy . The addition of paclitaxel to adjuvant doxorubicin followed by CMF significantly improved RFS compared with adjuvant doxorubicin alone followed by CMF ( hazard ratio [ HR ] , 0.73 ; P = .03 ) . Distant RFS was similarly improved ( HR , 0.70 ; P = .027 ) . There was no significant difference in RFS when the paclitaxel/doxorubicin/CMF chemotherapy was given before surgery compared with the same regimen given after surgery ( HR , 1.21 ; P = .18 ) . However , the rate of breast-conserving surgery was significantly higher with preoperative chemotherapy ( 63 % v 34 % ; P < .001 ) . CONCLUSION Incorporating paclitaxel into anthracycline-based adjuvant therapy result ed in a significant improvement in RFS and distant RFS . When given as primary systemic therapy , the paclitaxel-containing regimen allowed breast-sparing surgery in a significant percentage of patients
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 .