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 .
Postoperative dose-dense sequential versus concomitant administration of epirubicin and paclitaxel in patients with node-positive breast cancer: 5-year results of the Hellenic Cooperative Oncology Group HE 10/00 phase III Trial
To explore the impact of dose intensity ( DI ) in the adjuvant setting of breast cancer , a r and omized phase III trial was conducted comparing postoperative dose-dense sequential chemotherapy with epirubicin , paclitaxel , and cyclophosphamide , methotrexate and fluorouracil (CMF)in  high-risk breast cancer patients . From Oct 2000 to June 2005 , 1,121 node-positive patients were r and omized to dose-dense sequential epirubicin 110 mg/m2 and paclitaxel ( Taxol ® , Bristol Myers-Squibb , Princeton , NJ ) 250 mg/m2 ( group A ) , or concurrent epirubicin 83 mg/m2 and paclitaxel 187 mg/m2 ( group B ) , both followed by three cycles of “ intensified ” combination chemotherapy with CMF . By protocol design total cumulative dose and duration of treatment were identical in both groups . Dose intensity of epirubicin and paclitaxel was double in the dose-dense arm . Prophylactic treatment with granulocyte colony-stimulating factor was given with the dose-dense treatments . Disease-free survival ( DFS ) was the primary endpoint . At a median follow-up of 76 months , 253 patients ( 23 % ) had documented disease relapse ( 123 vs. 130 in groups A and B , respectively ) and 208  deaths  ( 101 , group A and 107 , group B ) had been observed . The 5-year DFS rate of 74 and 74 % and OS rate of 86 and 85 % were observed for group A and group B , respectively . No differences were found in DFS or OS between the two treatment groups ( P = 0.78 and P = 0.45 for DFS and OS , respectively ) . Safety analysis results showing that both regimens were well tolerated and safe have been previously published ( Fountzilas et al. Ann Oncol 2008 ) . No DFS or OS benefit from the dose-dense sequential epirubicin and paclitaxel was detected when compared to the concurrent administration of the same drugs . No additional safety issues were raised with long-term follow-up
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 .