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 trial of adjuvant epirubicin followed by cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) versus CMF followed by epirubicin in patients with node-negative or 1–3 node-positive rapidly proliferating breast cancer
Adjuvant cyclophosphamide , methotrexate , and 5-fluorouracil ( CMF ) have proven highly effective in rapidly proliferating breast cancer ( RPBC ) . It has also been seen that sequential administration of doxorubicin and CMF is superior to their alternation , especially in indolent tumors . In a phase III study , we evaluated whether adjuvant epirubicin ( E ) followed by CMF is superior to the inverse sequence in RPBC . Patients with node-negative or 1–3 node-positive RPBC ( Thymidine Labeling Index > 3 % or histological grade 3 or S-phase > 10 % or Ki67 > 20 % ) were r and omized to receive E ( 100 mg/m2 i.v . d1 , q21 days for 4 cycles ) followed by CMF ( 600 , 40 , 600 mg/m2 i.v . d1 and 8 , q28 days for 4 cycles ) ( E → CMF ) or CMF followed by E ( CMF → E ) or CMF for 6 cycles . From November 1997 to December 2004 , 1066 patients were enrolled :  E → CMF 440 , CMF → E 438 , and CMF 188 . At a median follow-up of 69 months , 5-year OS was 91 % ( 95 % CI 88–94 ) for E → CMF and 93 % ( 95 % CI 90–95 ) for CMF → E , with adjusted hazard ratio of 0.88 ( 95 % CI 0.58–1.35 ) , and DFS was 80 % in both arms , with adjusted hazard ratio of 0.99 ( 95 % CI 0.73–1.33 , Cox model ) . Adverse events were similar , apart from a higher rate of neutropenia in the CMF → E arm . No important differences in clinical outcome were observed between the two different sequences , making both a valid option in early breast cancer . Further molecular characterization of the tumors might help to identify subgroups achieving higher benefit from either sequence
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 .