Chemotherapy protocols #2

These adjuvant chemotherapy regimens can be used for patients with early-stage breast cancer: - Fluorouracil-epirubicin-cyclophosphamide X 3 → docetaxel X 3 (superior to fluorouracil epirubicin- cyclophosphamide X 6) - Doxorubicin-cyclophosphamide X 4 → docetaxel X 4 (superior to doxorubicin cyclophosphamide X 4) - Docetaxel-doxorubicin-cyclophosphamide X 6 (superior to fluorouracil doxorubicin cyclophosphamide X 6) - Doxorubicin-cyclophosphamide X 4 → paclitaxel administered once per week Dose-dense doxorubicin-cyclophosphamide → paclitaxel (once every 2 weeks) - Dose-dense epirubicin 90 mg/m2, cyclophosphamide 600 mg/m2 every 2 weeks 4 cycles → paclitaxel 175 mg/m2 every 2 weeks for 4 cycles) 

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. Of Note, the ASCO Panel recommends classic cyclophosphamidemethotrexate - fluorouracil (oral cyclophosphamide days 1 to 14 with IV methotrexate-fluorouracil days 1 and 8, repeated once every 28 days for six cycles) as the default adjuvant cyclophosphamidemethotrexate- 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)