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 weekly paclitaxel versus docetaxel in combination with capecitabine in operable breast cancer.
PURPOSE We investigated whether capecitabine and docetaxel followed by fluorouracil , epirubicin , and cyclophosphamide ( FEC ) or weekly paclitaxel ( WP ) followed by FEC would improve relapse-free survival ( RFS ) in operable breast cancer . PATIENTS AND METHODS In this single-institution study , patients with clinical stages I to IIIC breast cancer were r and omly assigned on a 1:1 basis to WP 80 mg/m(2 ) for 12 weeks followed by fluorouracil 500 mg/m(2 ) , epirubicin 100 mg/m(2 ) , and cyclophosphamide 500 mg/m(2 ) ( FEC-100 ) every 3 weeks for four cycles or docetaxel 75 mg/m(2 ) on day 1 and capecitabine ( XT ) 1,500 mg/m(2 ) on days 1 through 14 every 3 weeks for four cycles followed by FEC for four cycles and stratified by timing of chemotherapy ( preoperative v adjuvant ) . Accrual was stopped short of 930 patients on the basis of a Bayesian predictive calculation that additional accrual would be unlikely to change the qualitative comparison of the two regimens . RESULTS After enrollment of 601 patients and a median follow-up of 50 months , we observed no improvement in RFS between XT ( 87.5 % ; 95 % CI , 82.7 % to 91.1 % ) and WP ( 90.7 % ; 95 % CI , 86.4 % to 93.7 % ; P = .51 ) . In the preoperative group , the pathologic complete response rate was 19.8 % and 16.4 % in the XT and WP arms , respectively ( P = .45 ) . Rates of breast-conserving surgery were similar between the two groups ( P = .48 ) . The XT arm had a significantly higher incidence of stomatitis ( P < .001 ) , h and -foot syndrome ( P < .001 ) , and neutropenic infection ( P < .001 ) . CONCLUSION There was no difference in efficacy between WP and XT as used in this r and omized phase III trial . XT was associated with higher GI , skin , and neutropenic-related toxicities
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 .