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 phase III adjuvant randomised trial of 6 cycles of 5-fluorouracil-epirubicine-cyclophosphamide (FEC100) versus 4 FEC 100 followed by 4 Taxol (FEC-T) in node positive breast cancer patients (Trial B2000).
BACKGROUND St and ard adjuvant chemotherapy regimens for patients with node positive ( N+ ) breast cancer consisted of anthracycline followed by taxane . The European Association for Research in Oncology embarked in 2000 on a phase III trial comparing 6 cycles of FEC100 versus 4 FEC100 followed by 4 Taxol . Primary end-point was disease free survival . Secondary end-points were overall survival , local recurrence free interval , metastases free interval and safety . PATIENTS AND METHODS Between March 2000 and December 2002 , 837 patients were r and omised between 6FEC100 for 6 cycles ( 417 patients ) or FEC100 for 4 cycles then Taxol 175mg/m(2)/3 weeks for 4 cycles ( 4FEC100 - 4 T ) ( 420 patients ) . One thous and patients had been planned initially but the trial was closed earlier due to slow accrual . RESULTS Hazard ratios ( HRs ) were 0.99 for disease-free survival ( DFS ) ( 95%CI : 0.77 - 1.26 ; p=0.91 ) , and 0.85 for overall survival ( OS ) ( 95%CI : 0.62 - 1.15 ; p=0.29 ) . Nine-year DFS were 62.9 % versus 62.5 % for 6FEC100 and 4FEC100 - 4 T , respectively . Nine-year OS were 73.9 % versus 77 % for 6FEC100 and 4FEC100 - 4 T , respectively . Toxicity analyses based on 803 evaluable patients showed that overall grade 3 - 4 toxicities were similar in both arms ( 63 % versus 58 % for 6FEC100 arm and 4FEC100 - 4 T arm , respectively ; p=0.16 ) . CONCLUSION In this trial replacing the last 2 FEC100 cycles of 6FEC100 regimen by 4 Taxol does not lead to a discernable DFS or OS advantage . The lack of a significant difference between the r and omised treatment arms may however be due to a lack of power of this trial to detect small , yet clinical ly worthwhile , treatment benefits
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 .