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 .
Sequential docetaxel as adjuvant chemotherapy for node-positive or/and T3 or T4 breast cancer: clinical outcome (Mansoura University)
This trial compared 6 cycles of fluorouracil , epirubicin , and cyclophosphamide ( FEC ) with a sequential regimen of 3 cycles of FEC followed by 3 cycles of docetaxel ( FEC-D ) as adjuvant treatment for women with node-positive or/ and T3 or T4 breast cancer . Between January 2006 and January 2010 , 657 patients with operable breast cancer were r and omly assigned to either FEC every 21 days for 6 cycles , or 3 cycles of FEC followed by 3 cycles of docetaxel , both given every 21 days . Radiotherapy was m and atory for all patients who had undergone breast conserving surgery . Radiation to the chest wall , supraclavicular area , was recommended following mastectomy . Hormone-receptor – positive patients received tamoxifen for 5 years after chemotherapy . The primary end point was 5-year disease-free survival ( DFS ) . Median follow-up was 61 months . Five-year DFS rates were 74 % with FEC and 78 % with FEC-D ( P = 0.013 ) . Multivariate analysis adjusted for prognostic factors showed a 17 % reduction in the relative risk of relapse with FEC-D.  Five-year overall survival rates were 85 % with FEC and 89.4 % with FEC-D , demonstrating a 27 % reduction in the relative risk of death ( P = 0.014 ) . The incidence of grade 3–4 neutropenia , the need for hematopoietic growth factor , and incidence of nausea/vomiting were higher with FEC . Docetaxel was associated with more febrile neutropenia , stomatitis , edema , and nail disorders . Though rare overall , there were fewer cardiac events after FEC-D , attributable mainly to the lower anthracycline cumulative dose . Sequential adjuvant chemotherapy with FEC followed by docetaxel significantly improves disease-free and overall survival in node-positive or/ and T3 or T4 breast cancer patients . Although the magnitude of the benefit observed with FEC-D , differences in the toxicity profiles of FEC and FEC-D may influence the choice of treatment for 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 .