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 .
Five-year outcome for women randomised in a phase III trial comparing doxorubicin and cyclophosphamide with doxorubicin and docetaxel as primary medical therapy in early breast cancer: an Anglo-Celtic Cooperative Oncology Group Study
To compare the long-term outcome of women with primary or locally advanced breast cancer r and omised to receive either doxorubicin and cyclophosphamide ( AC ) or doxorubicin and docetaxel ( AD ) as primary chemotherapy . Eligible patients with histologic-proven breast cancer with primary tumours ≥3 cm , inflammatory or locally advanced disease , and no evidence of distant metastases , were r and omised to receive a maximum of 6 cycles of either doxorubicin ( 60 mg/m2 ) plus cyclophosphamide ( 600 mg/m2 ) i/v or doxorubicin ( 50 mg/m2 ) plus docetaxel ( 75 mg/m2 ) i/v every 3 weeks , followed by surgery on completion of chemotherapy . Clinical and pathologic responses have previously been reported . Time to relapse , site of relapse , and all-cause mortality were recorded . This up date d analysis compares long-term disease-free ( DFS ) and overall survival ( OS ) using stratified log rank methods . A total of 363 patients were r and omised to AC ( n = 181 ) or AD ( n = 182 ) .  A complete pathologic response was observed in 16 % for AC and 12 % for AD ( P = 0.43 ) . The number of patients with positive axillary nodes at surgery with AC was 61 % and AD 66 % ( P = 0.36 ) . At a median follow-up of 99 months there is no significant difference between the two groups for DFS ( P = 0.20 ) and OS ( P = 0.24 ) . Deaths were due to metastatic breast cancer in 96 % of patients . Our data do not support a clinical benefit for simultaneous administration of AD compared with AC . However , the data do not exclude a smaller benefit than the study was powered to detect and are consistent with an increase in both disease-free and overall survival of about 5 % for AD compared with AC . Outcome is consistent with the pathologic complete response following surgery
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 .