Adjuvant Regimen When an Anthracycline Is Not Preferred
➤ Docetaxel-cyclophosphamide x 4 is recommended as an alternative to
doxorubicin-cyclophosphamide x 4 and offers improved disease-free survival
and overall survival. Classic cyclophosphamide-methotrexate-fluorouracil with
oral cyclophosphamide for six cycles is another option.
• As mentioned before, the ASCO Panel recommends classic cyclophosphamide-
methotrexate-fluorouracil (oral cyclophosphamide days 1–14 with 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) on the basis of its convenience and
tolerability despite the absence of efficacy data from randomized controlled trials.
Patient Selection and Adjuvant Trastuzumab Therapy
➤ Only patients with HER2-positive breast cancer (overexpressed based on
immunohistochemistry [3+] or amplified based on in situ hybridization
[ratio ≥2.0 or average HER2 copy number ≥6.0]) should be offered adjuvant
trastuzumab.
Trastuzumab Plus Chemotherapy in Patients with Higher-Risk
HER2-Positive Disease
➤ Trastuzumab plus chemotherapy is recommended for all patients with HER2-
positive, node-positive breast cancer and for patients with HER2-positive,
node-negative breast cancer (>1 cm).*
Trastuzumab Plus Chemotherapy in Patients with HER2-Positive
T1a-B N0 Disease
➤ Trastuzumab therapy can be considered in small, node-negative tumors
(≤1 cm).
Selection of Chemotherapy Regimens in Patients Receiving
Trastuzumab
➤ Trastuzumab can be administered with any acceptable adjuvant chemotherapy
regimen.*
Treatment
