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 study of adjuvant doxorubicin plus cyclophosphamide (AC) → docetaxel (T) with or without capecitabine (X) in high-risk early breast cancer: Exploratory Ki-67 analyses.
500 Background : First results of study USON 01062 comparing adjuvant AC→T vs AC→XT in high-risk EBC [ O'Shaughnessy , SABCS 2010 ] showed the primary endpoint , improvement in DFS , was not met ( median FU 5 yrs : HR 0.84 , 95 % CI : 0.67 - 1.05 ; p%0.125 ; 304 events ) , but a statistically significant improvement in OS was seen with AC→XT ( HR 0.68 , 95 % CI : 0.51 - 0.92 ; p%0.011 ; 183 events ) . Given the current underst and ing of a lesser benefit of adjuvant chemotherapy in indolent BC , we performed unplanned exploratory subset analyses of Ki-67 expression , distant DFS and benefit from XT . METHODS Pts aged 18 - 70 yrs with surgically resectable EBC received 4 x 3-weekly AC ( A : 60mg/m2 , C : 600mg/m2 , d1 ) → 4 x 3-weekly T ( 100mg/m2 d1 ) or XT ( X : 825mg/m2 bid , d1 - 14 ; T : 75mg/m2 d1 ) . ER+ pts received endocrine therapy , and , after 2005 , HER2 + pts were offered 1-yr of trastuzumab . Primary endpoint : DFS ; secondary endpoints : OS ; safety . Ki-67 staining was done locally . RESULTS 2,611 pts were r and omized : AC→T ( n%1304 ) ; AC→XT ( n%1307 ) . Treatment arms were balanced . Exploratory distant DFS analysis favored the XT group ( HR 0.80 , 95 % CI : 0.63 - 1.02 ; p%0.067 ) . Analyses by Ki-67 expression showed a treatment effect with XT vs T in pts with Ki-67 ≥10 % ( HR for DFS : 0.70 ; OS : 0.52 ) ( table ) . Very few events ( DFS/OS ) were seen in pts with Ki-67 < 10 % , with no difference in DFS with XT vs T. In pts with ER+/HER2- tumors and Ki-67 ≥10 % , a trend towards DFS ( HR 0.66 ) and OS ( 0.30 ) benefit with XT was also seen . CONCLUSIONS Exploratory Ki-67 analyses suggested benefit of X in more highly proliferative tumors , reflecting the importance of pt selection in adjuvant trials . [ Table : see text ]
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 .