Adjuvant chemotherapy of breast cancer

Breast cancer is the most common cancer and the second most common cause of cancer-related death in women. The last three decades have yielded marked progress in the diagnosis and management of breast cancer. Not only is the disease being detected at a much earlier stage, but the addition of systemic therapy has also improved survival. Cyclophosphamide (C), methotrexate (M) and 5-fluorouracil (F)(CMF) combination chemotherapy was among the first chemotherapy regimens found to prolong both disease-free survival (DFS) and overall survival (OS) when given in the adjuvant setting. The 2000 Oxford overview confirmed that anthracycline-based chemotherapy offers a survival advantage compared with CMF. Anthracycline-based therapies are better tolerated in terms of acute side effects but long-term sequels (cardiotoxicity, secondary leukaemia) are worrisome. It seems that more intensive three-drug regimens (FE[epirubicin](100)C, CEF, CA[adriamycin]F,) or the combination of E+CMF are more active in reducing the risk of relapse and death in breast cancer patients. The reported trials with taxanes demonstrated comparable reduction in the risk of recurrence and death, although administration of paclitaxel (T)-containing regimens appears to be most effective if administered on an every-2-week schedule with granulocyte colony-stimulating factor (G-CSF). The risk of febrile neutropenia is highest for the TAC regimen (~25%), although other trials have demonstrated that use of G-CSF will reduce this complication to about 3%.