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 .
Response-guided neoadjuvant chemotherapy for breast cancer.
PURPOSE We investigated disease-free survival ( DFS ) and overall survival ( OS ) after response-guided neoadjuvant chemotherapy in patients with early breast cancer . PATIENTS AND METHODS We treated 2,072 patients with two cycles of docetaxel , doxorubicin , and cyclophosphamide ( TAC )  and r and omly assigned early responders to four ( n = 704 ) or six ( n = 686 ) additional TAC cycles , and early nonresponders to four cycles of TAC ( n = 321 ) or vinorelbine and capecitabine ( NX ; n = 301 ) before surgery . RESULTS DFS was longer in early responders receiving TAC × 8 than in those receiving TAC × 6 ( hazard ratio [ HR ] , 0.78 ; 95 % CI , 0.62 to 0.97 ; P = .026 ) , and in early nonresponders receiving TAC-NX than in those receiving TAC × 6 ( HR , 0.59 ; 95 % CI , 0.49 to 0.82 ; P = .001 ) . Exploratory analysis showed that DFS  after response-guided chemotherapy ( TAC × 8 or TAC-NX ) was significantly longer ( HR , 0.71 ; 95 % CI , 0.60 to 0.85 ; P < .003 ) , as was OS ( HR , 0.79 ; 95 % CI , 0.63 to 0.99 ; P = .048 ) , than on conventional chemotherapy ( TAC × 6 ) . DFS was longer after response-guided chemotherapy in all hormone receptor-positive tumors ( luminal A HR = 0.55 , luminal B [ human epidermal growth factor receptor 2 ( HER2 ) negative ] HR = 0.40 , and luminal B [ HER2 positive ] HR = 0.56 ) , but not in hormone receptor-negative tumors ( HER2 positive [ nonluminal ] HR = 1.01 and triple negative HR = 0.87 ) . Pathologic complete response did not predict these survival effects . pCR predicted an improved DFS in triple-negative ( HR = 6.67 ) , HER2-positive ( nonluminal ; HR 5.24 ) , or luminal B ( HER2-negative ) tumors ( HR = 3.74 ) . CONCLUSION This exploratory analysis suggests that response-guided neoadjuvant chemotherapy might improve survival and is most effective in hormone receptor-positive tumors . If confirmed , the response-guided approach could provide a clinical ly meaningful advantage for the neoadjuvant over the adjuvant approach in early breast cancer
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 .