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 .
PREPARE trial: a randomized phase III trial comparing preoperative, dose-dense, dose-intensified chemotherapy with epirubicin, paclitaxel, and CMF versus a standard-dosed epirubicin-cyclophosphamide followed by paclitaxel with or without darbepoetin alfa in primary breast cancer--outcome on prognosi
BACKGROUND The objective of this study was to compare the effect of dose-intensified neoadjuvant chemotherapy with that of st and ard epirubicin plus cyclophosphamide followed by paclitaxel in combination with or without darbepoetin on survival in primary breast cancer . PATIENTS AND METHODS A total of 733 patients received either four cycles of neoadjuvant epirubicin 90 mg/m(2 ) plus cyclophosphamide 600 mg/m(2 ) every 3 weeks followed by four cycles of paclitaxel 175 mg/m(2 ) every 3 weeks ( EC→T ) , or three cycles of epirubicin 150 mg/m(2 ) every 2 weeks followed by three cycles of paclitaxel 225 mg/m(2 ) every 2 weeks followed by three cycles of combination chemotherapy with cyclophosphamide , methotrexate , and fluorouracil ( E(dd)→T(dd)→CMF ) . The patients were r and omly assigned to receive darbepoetin or none . The primary objective was to demonstrate a superior disease-free survival ( DFS ) of E(dd)→T(dd)→CMF compared with EC→T. RESULTS Estimated 3-year DFS was 75.8 % with EC→T versus 78.8 % with E(dd)→T(dd)→CMF [ hazard ratio ( HR ) 1.14 ; P = 0.37 ] and overall survival ( OS ) 88.4 % versus 91.5 % ( HR 1.26 ; P = 0.237 ) . Three-year DFS was 74.3 % with darbepoetin versus 80.0 % without ( HR 1.31 ; P = 0.061 ) and OS 88.0 % versus 91.8 % ( HR 1.33 ; P = 0.139 ) . Patients with  a pathologically documented complete response [ pathological complete response ( pCR ) ] had a significantly better DFS compared with those without achieving a pCR ( estimated 3-year DFS : 89.2 % versus 74.9 % ; HR 2.27 ; P = 0.001 ) . CONCLUSION Neoadjuvant dose-intensified chemotherapy compared with st and ard chemotherapy did not improve DFS , whereas the addition of darbepoetin might have detrimental effects on DFS
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 .