Abstract
In both early and advanced breast cancer, chemotherapy forms a vital component of most treatment algorithms, despite the arrival of targeted agents. The number of agents with meaningful activity is large, particularly in advanced disease, and the choice of regimen must take into account predicted efficacy and toxicity in the context of prognostic factors and patient wishes. Several chemotherapy regimens may exist for a given clinical situation, and selecting an optimal treatment can be difficult, despite progress in the understanding of molecular subtypes and relevant mutations. In early-stage disease, the superiority of one regimen over another must be considered in the context of the absolute risk of relapse. Additionally, luminal subtypes may have lower overall chemosensitivity, which can influence choice. In advanced disease, tolerability plays a greater role. The use of tumour subtype or genomic markers such as BRCA mutation to assist in selecting optimal agents is promising but remains investigational. This chapter will consider the range of chemotherapy options available and offer evidence-based suggestions for current management.
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Abbreviations
- AC:
-
Doxorubicin plus cyclophosphamide, 4 cycles given 3 weekly (2 weekly for dose-dense) (×4, q21 or q14)
- CMF:
-
Cyclophosphamide, methotrexate, fluorouracil, ×6 q28 (d1+d8)
- FEC:
-
Fluorouracil, epirubicin, cyclophosphamide, ×6 q21
- EC:
-
Epirubicin cyclophosphamide
- (F)EC-D:
-
Epirubicin plus cyclophosphamide (with or without fluorouracil) ×3 followed by docetaxel ×3, q21 (or q14 for dose-dense)
- TC:
-
Docetaxel cyclophosphamide ×4 q21
- TCH:
-
Docetaxel cyclophosphamide trastuzumab ×4 q21, trastuzumab continued for total 1 year
- TCarboH:
-
Docetaxel carboplatin trastuzumab ×6 q21, trastuzumab continued for total 1 year
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Hart, C.D., Biganzoli, L., Di Leo, A. (2017). Chemotherapy Regimens in the Adjuvant and Advanced Disease Settings. In: Veronesi, U., Goldhirsch, A., Veronesi, P., Gentilini, O., Leonardi, M. (eds) Breast Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-48848-6_46
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