Key Points
➤ Adjuvant chemotherapy improves disease-free survival (DFS) and overall
survival (OS) independent of age, nodal status, and estrogen receptor (ER)
status.
• However, those with triple-negative and human epidermal growth factor receptor 2
(HER2)–positive breast cancer seem to derive the greatest proportional benefit from
systemic chemotherapy and biologic therapy.
➤ The potential benefits and risks need to be carefully weighed before rendering a
decision to administer chemotherapy.
• Comorbidities and burden of disease need to be considered for selection of optimal
regimens.
Treatment
NOTE: Recommendations identified by an asterisk (
*
) are taken verbatim from
the Cancer Care Ontario [CCO] guideline. Otherwise, recommendations have
been substantively adapted or reworded for clarity by the American Society of
Clinical Oncolog y [ASCO] Panel.
Use of an Anthracycline-Taxane Regimen
➤ In patients who can tolerate it, use of a regimen containing anthracycline-taxane
is considered the optimal strategy for adjuvant chemotherapy, particularly for
patients deemed to be at high risk.*
Optimal-Dose Anthracycline Regimen for Patients for Whom a
Taxane Is Contraindicated
➤ For patients with high-risk disease who will not receive a taxane, an optimal-
dose anthracycline three-drug regimen (cumulative dose of doxorubicin
≥240 mg/m
2
or epirubicin ≥600 mg/m
2
but ≤720 mg/m
2
) that contains
cyclophosphamide is recommended. The cumulative dose of doxorubicin in two-
drug regimens should not exceed 240 mg/m
2
.
