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 .
Taxane-induced peripheral neuropathy and health-related quality of life in postoperative breast cancer patients undergoing adjuvant chemotherapy: N-SAS BC 02, a randomized clinical trial
Purpose To eluci date whether adjuvant taxane monotherapy is a feasible and tolerable for postoperative breast cancer patients , we evaluated the severity of chemotherapy-induced peripheral neuropathy ( CIPN ) and the relative tolerability of regimens by health-related quality of life ( HRQOL ) assessment in node-positive breast cancer patients treated with taxane-containing regimens . Methods We evaluated CIPN and HRQOL in the first 300 patients enrolled in a larger ( 1,060 total ) multicenter phase III trial r and omized to one of four adjuvant regimens :  ( 1 ) anthracycline – cyclophosphamide followed by paclitaxel ( ACP ) , ( 2 ) AC followed by docetaxel ( ACD ) , ( 3 ) paclitaxel alone ( PTX ) , or ( 4 ) docetaxel alone ( DTX ) . CIPN was assessed by the Patient Neurotoxicity Question naire ( PNQ ) and the National Cancer Institute Common Toxicity Criteria , and HRQOL by Functional Assessment of Cancer Therapy-General ( FACT-G ) . CIPN and HRQOL scores were compared between ACP and ACD vs. PTX and DTX , and ACP and PTX vs. ACD and DTX . Results PNQ sensory scores were significantly higher in patients treated with taxane monotherapy compared to treatment with AC followed by taxane ( P = .003 ) . No significant differences in PNQ sensory scores were observed between the ACP and PTX vs. ACD and DTX regimens ( P = .669 ) . Regardless of taxane regimen , PNQ severity scores for CIPN appear to be largely reversible within 1 year of adjuvant treatment . No significant difference in FACT-G scores was observed between any regimens during the study treatments . Conclusions Patient-reported CIPN was significantly more severe with single-agent adjuvant taxane compared to AC followed by taxane treatment ; however , the HRQOL findings support that single-agent taxane treatment is tolerable
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 .