The current state of adjuvant therapy for breast cancer: focus on paclitaxel

Combination chemotherapy may necessitate reduction from optimal doses for many of the component agents to minimize the risk of additive toxicity. Several strategies have been investigated to overcome the diminished cell kill resulting from less than optimal dosing. Key among these are dose-dense therapy (using the shortest possible intertreatment interval of the reduced doses to increase the dose intensity and take advantage of tumor cell kinetics) and use of new and novel anticancer agents. Paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ), the first of the taxane drugs, has come to have a quite significant role in the new strategies because of its unique mechanism of action and lack of cross-resistance with other active agents. These two strategies have been examined alone and in combination in the adjuvant therapy of breast cancer and the results of many of these studies are presented here. Overall, progress is being made with dose-dense regimens and with paclitaxel-containing combinations, and each may play a role in the future of breast cancer management.