Treatment
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.*
Adding Gemcitabine or Capecitabine to an Anthracycline-Taxane
Regimen
➤ The addition of gemcitabine or capecitabine to an anthracycline-taxane regimen
is NOT recommended for adjuvant chemotherapy.*
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
.
Capecitabine in Patients Age ≥65 Years
➤ In patients age ≥65 years, capecitabine is NOT recommended as an adjuvant
chemotherapy option in lieu of standard regimens such as doxorubicin-
cyclophosphamide or cyclophosphamide-methotrexate-fluorouracil (with oral
cyclophosphamide).
Cyclophosphamide-Methotrexate-Fluorouracil As an Alternative
To Doxorubicin-Cyclophosphamide
➤ For patients in whom anthracycline-taxane is contraindicated,
cyclophosphamide-methotrexate-fluorouracil (with oral cyclophosphamide) is an
acceptable chemotherapy alternative to doxorubicin-cyclophosphamide.
• Of note, the ASCO Panel recommends classic cyclophosphamide-methotrexate-
fluorouracil (oral cyclophosphamide days 1–14 with intravenous [IV] methotrexate-
fluorouracil days 1 and 8, repeated once every 28 days for six cycles) as the default
adjuvant cyclophosphamide-methotrexate-fluorouracil regimen.
• However, the Panel also recognizes that an all-IV cyclophosphamide-methotrexate-
fluorouracil regimen once every 21 days is often used in clinical practice and was
accepted by some clinical trials (e.g., TAILORx; Trial Assigning Individualized Options
for Treatment [Rx]) on the basis of convenience and tolerability despite the absence of
efficacy data from randomized controlled trials.
