Treatment
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.*
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 (eg, 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.
Acceptable Adjuvant Chemotherapy Regimens for Patients with
Higher-Risk Early Breast Cancer
➤ These adjuvant chemotherapy regimens can be used for patients with early
breast cancer:
• Fluorouracil-epirubicin-cyclophosphamide × 3 → docetaxel × 3
(superior to fluorouracil-epirubicin-cyclophosphamide x 6)
• Doxorubicin-cyclophosphamide × 4 → docetaxel × 4
(superior to doxorubicin-cyclophosphamide × 4)
• Docetaxel-doxorubicin-cyclophosphamide × 6
(superior to fluorouracil-doxorubicin-cyclophosphamide × 6)
• Doxorubicin-cyclophosphamide × 4 → paclitaxel administered once per week
• Dose-dense doxorubicin-cyclophosphamide → paclitaxel administered once every
2 weeks
• Dose-dense epirubicin 90 mg/m
2
, cyclophosphamide 600 mg/m
2
every 2 weeks × 4 →
paclitaxel 175 mg/m
2
every 2 weeks × 4
