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 .
Ki67 expression and docetaxel efficacy in patients with estrogen receptor-positive breast cancer.
PURPOSE The indications of adjuvant chemotherapy for patients with estrogen receptor ( ER ) -positive breast cancer are controversial . We analyzed the predictive value of Ki67 , HER2 , and progesterone receptor ( PR ) expression for the efficacy of docetaxel in patients with ER-positive , node-positive breast cancer . PATIENTS AND METHODS Expression of Ki67 , HER2 , and PR was measured by immunohistochemistry in tumor sample s from 798 patients with ER-positive breast cancer who participated in PACS01 , a r and omized trial that evaluated the efficacy of docetaxel . Risk reduction was evaluated using a Cox model adjusted for age , tumor size , nodal involvement , treatment arm , and biomarkers . The predictive value of biomarkers was assessed by an interaction test . Disease-free survival ( DFS ) was the primary end point . Results Ki67 , HER2 , and PR were expressed in 21 % , 9 % , and 62 % of sample s , respectively . Hazard ratios for relapse associated with docetaxel were 0.51 ( 95 % CI , 0.26 to 1.01 ) in ER-positive/Ki67-positive tumors and 1.03 ( 95 % CI , 0.69 to 1.55 ) in ER-positive/Ki67-negative tumors ( ratio for interaction : 0.53 ; 95 % CI , 0.24 to 1.16 ; P = .11 ) . Five-year DFS rates were 81 % ( 95 % CI , 76 % to 86 % ) and 84 % ( 95 % CI , 75 % to 93 % ) in patients with ER-positive/Ki67-negative and ER-positive/Ki67-positive tumors treated with docetaxel and 81 % ( 95 % CI , 76 % to 86 % ) and 62 % ( 95 % CI , 52 % to 72 % ) in patients with ER-positive/Ki67-negative and ER-positive/Ki67-positive tumors treated with fluorouracil , epirubicin , and cisplatin . No trend for interaction was observed between docetaxel and HER2 ( ratio for interaction : 0.83 ; 95 % CI , 0.35 to 1.94 ; P = .66 ) , nor between docetaxel and PR ( ratio for interaction : 0.89 ; 95 % CI , 0.47 to 1.66 ; P = .71 ) . CONCLUSION Ki67 expression identifies a subset of patients with ER-positive breast cancer who could be sensitive to docetaxel treatment in the adjuvant setting
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 .