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 .
The SUCCESS-C trial: Interim analysis of toxicity evaluating the role of an anthracycline-free chemotherapy regimen in the adjuvant treatment of HER2/neu-negative breast cancer.
1070 Background : Taxane-based anthracycline containing chemotherapy has been established as treatment option in the adjuvant setting of early breast cancer . Indication was recently enlarged for high risk node negative breast cancer . Promising retrospective data indicate equi-efficacy of anthracycline-free chemotherapy in Her2/neu-negative patients ( Gennari et al. , Slamon et al. ) . Anthracycline-free regimens are probably associated with less long-term toxicities , especially cardiac toxicities . METHODS The SUCCESS-C trial is an open-label , multicenter , 2x2 factorial design , r and omized controlled , phase III study comparing the disease free survival in patients treated with 3 cycles fluorouracil 500mg/m2-epirubicine 100mg/m2-cyclophosphamide 500mg/m2 ( FEC ) chemotherapy , followed by 3 cycles docetaxel 100mg/m2 ( D ) chemotherapy , versus 6 cycles docetaxel 75mg/m2-cyclophosphamide 600mg/m2 ( DC ) chemotherapy .  Monitored toxicity data after end of treatment are available from 1,452 patients . RESULTS Chemotherapy was prematurely stopped in 51 pts ( 7.2 % ) receiving FEC-D and in 57 pts ( 7.7 % ) with DC ( p=0.71 ) . Dose reductions occurred significantly more often in the FEC-D arm ( 2.7 % ) than in the DC arm ( 1.9 % , p=0.024 ) , reasons did not differ significantly between both arms ( p=0.093 ) . Incidence of treatment-postponement was significantly higher for FEC-D ( 9.4 % FEC-D vs. 7.6 % DC ; p=0.0008 ) . Haematological toxicity as a reason for treatment-postponement occurred significantly more frequent within the FEC-D-arm ( FEC-D : 18.1 % , DC : 6.6 % , p<0,0001 ) ; non-haematological toxicity as a reason for treatment postponement was nearly equal within both arms ( 8.6 % FEC-D vs. 8.8 % DC , p=0.9 ) . G-CSF support was applied in 22.7 % of all chemotherapy cycles ( FEC-D : 22.2 % vs. DC : 23.2 % , p=0.21 ) . Severe toxicities ( NCI- grade > 2 ) were reported in 910 cases for FEC-D and in 848 cases for DC arm ( p= 0.02 ) . CONCLUSIONS Significantly more dose-reductions of chemotherapy and a significant higher incidence of treatment-postponement occurred in the FEC-D arm . The toxicity profiles of both treatment arms differ discretely and support the continuation of the trial until target recruitment ( n=3,547 )
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 .