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 .
Randomized, phase III trial of sequential epirubicin and docetaxel versus epirubicin alone in postmenopausal patients with node-positive breast cancer.
PURPOSE The Docetaxel Epirubicin Adjuvant ( DEVA ) trial evaluated the efficacy and toxicity of incorporating docetaxel after epirubicin to create a sequential anthracycline-taxane regimen in early breast cancer . PATIENTS AND METHODS After complete tumor excision , postmenopausal women with node-positive early breast cancer were r and omly assigned to either epirubicin 50 mg/m(2 ) on days 1 and 8 every 4 weeks for six cycles ( EPI × 6 ) or three cycles of epirubicin 50 mg/m(2 ) on days 1 and 8 every 4 weeks followed by three cycles of docetaxel 100 mg/m(2 ) on day 1 every 3 weeks ( EPI-DOC ) . A subset of patients also participated in a quality of life ( QOL ) study . The primary end point was disease-free survival ( DFS ) . RESULTS From 1997 to 2005 , 803 patients entered DEVA ( EPI × 6 , n = 397 ; EPI-DOC , n = 406 ) . At a median follow-up of 64.7 months ( interquartile range , 45.2 to 84.4 months ) , 198 DFS events had been reported ( EPI × 6 , n = 114 ; EPI-DOC , n = 84 ) . The 5-year DFS rates were 72.7 % ( 95 % CI , 68.0 % to 77.3 % ) for epirubicin alone and 79.5 % ( 95 % CI , 75.2 % to 83.8 % ) for epirubicin followed by docetaxel ; evidence of improvement in DFS was observed with EPI-DOC ( hazard ratio [ HR ] , 0.68 ; 95 % CI , 0.52 to 0.91 ; P = .008 ) . One hundred twenty-seven patients have died ( EPI × 6 , n = 75 ; EPI-DOC , n = 52 ) ; a reduction in deaths was observed with EPI-DOC ( HR , 0.66 ; 95 % CI , 0.46 to 0.94 ; P = .02 ) . The 5-year overall survival rates were 81.8 % ( 95 % CI , 77.7 % to 85.9 % ) for epirubicin and 88.9 % ( 95 % CI , 85.5 % to 92.2 % ) for epirubicin followed by docetaxel . Assessment of toxicity and QOL showed that EPI-DOC was associated with greater toxicity but with no difference in QOL between arms during follow-up . CONCLUSION These results suggest , within a relatively small trial , that substitution of docetaxel for epirubicin for the last three cycles of chemotherapy results in improved outcome in postmenopausal women with node-positive , early breast cancer compared with six cycles of epirubicin monotherapy
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 .