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 .
Adjuvant docetaxel for node-positive breast cancer.
BACKGROUND We compared docetaxel plus doxorubicin and cyclophosphamide ( TAC ) with fluorouracil plus doxorubicin and cyclophosphamide ( FAC ) as adjuvant chemotherapy for operable node-positive breast cancer . METHODS We r and omly assigned 1491 women with axillary node-positive breast cancer to six cycles of treatment with either TAC or FAC as adjuvant chemotherapy after surgery . The primary end point was disease-free survival . RESULTS At a median follow-up of 55 months , the estimated rates of disease-free survival at five years were 75 percent among the 745 patients r and omly assigned to receive TAC and 68 percent among the 746 r and omly assigned to receive FAC , representing a 28 percent reduction in the risk of relapse ( P=0.001 ) in the TAC group . The estimated rates of overall survival at five years were 87 percent and 81 percent , respectively . Treatment with TAC result ed in a 30 percent reduction in the risk of death ( P=0.008 ) . The incidence of grade 3 or 4 neutropenia was 65.5 percent in the TAC group and 49.3 percent in the FAC group ( P<0.001 ) ; rates of febrile neutropenia were 24.7 percent and 2.5 percent , respectively ( P<0.001 ) . Grade 3 or 4 infections occurred in 3.9 percent of the patients who received TAC and 2.2 percent of those who received FAC ( P=0.05 ) ; no deaths occurred as a result of infection . Two patients in each group died during treatment . Congestive heart failure and acute myeloid leukemia occurred in less than 2 percent of the patients in each group . Quality -of-life scores decreased during chemotherapy but returned to baseline levels after treatment . CONCLUSIONS Adjuvant chemotherapy with TAC , as compared with FAC , significantly improves the rates of disease-free and overall survival among women with operable node-positive 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 .