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 .
Phase III multicenter trial of doxorubicin plus cyclophosphamide followed by paclitaxel compared with doxorubicin plus paclitaxel followed by weekly paclitaxel as adjuvant therapy for women with high-risk breast cancer.
PURPOSE This study compared disease-free survival ( DFS ) obtained with two different regimens of adjuvant therapy in high-risk breast cancer . METHODS Women ( who had performance status [ PS ] of 0 to 1 ) with operable , histologically confirmed , stage I to III adenocarcinoma of the breast were eligible . Patients had undergone primary surgery with no residual tumor . Treatments were as follows : arm 1 was doxorubicin 60 mg/m(2 ) plus cyclophosphamide 600 mg/m(2 ) every 3 weeks for four cycles followed by paclitaxel 175 mg/m(2 ) every 3 weeks for four cycles ( ie , AC-P ) ; and arm 2 was doxorubicin 50 mg/m(2 ) plus paclitaxel 200 mg/m(2 ) every 3 weeks for four cycles followed by paclitaxel 80 mg/m(2 ) weekly for 12 weeks . RESULTS Overall , 1,830 patients were enrolled and 1,801 were treated : arm 1 ( n = 906 ; AC-->P ) and arm 2 ( n = 895 ; AP-WP ) . Overall , patients had a PS of 0 ( 88 % ) , had estrogen receptor and progesterone receptor-positive disease ( 52 % ) , had one to three positive nodes ( 46 % ) , and were postmenopausal ( 57 % ) ; the median age was 52 years . Currently , 1,640 patients ( 90 % ) are alive . The 6-year DFS was 79 % to 80 % in both groups . Disease relapse was the cause of death for 83 patients in arm 1 and in 66 patients of arm 2 . Overall 6-year survival rates were 82 % and 87 % in arms 1 and 2 , respectively . Reasons for patients being taken off study treatment included toxicity ( 13 % in arm 1 v 20 % in arm 2 ) , progressive disease or recurrence ( 7 % v 5 % ) , and consent withdrawn ( 9 % v 8 % ) , respectively . The most frequent toxicities were hematologic , including neutropenia and leukopenia followed by neuropathy , myalgia , nausea , fatigue , headache , arthralgia , and vomiting . CONCLUSION The results indicate that the AP-WP regimen is an equally effective and tolerable option for the adjuvant treatment of patients with high-risk breast cancer . The substitution of paclitaxel for cyclophosphamide results in comparable effectiveness of the regimen
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 .