The best use of adjuvant chemotherapy: New drugs and new use of “old” drugs

Modern chemotherapy has diminished the risks of distant relapse and death in many subgroups of patients with early stage breast cancer. Although the initial trials relied on empirically designed regimens, studies are increasingly based on preclinical science and reflect the growing understanding of the molecular basis of cancer. Empiric clinical trials proved the worth of combination chemotherapy, the limited value of very long courses of treatment, and the benefits of adding first anthracyclines and then later taxanes. More recent trials have demonstrated the limits on empiric dose escalation and the benefits of optimized scheduling. Many trials are currently focused on novel targeted agents. Based on several decades of studies in thousands of women it is reasonable to consider a combination of chemotherapy agents for patients with hormone unresponsive or otherwise high-risk tumors. Anthracyclines and taxanes should be incorporated into the treatment plans of patients in the higher risk subsets and the specific regimens should be taken from the several randomized studies. When available, eligible patients should be enrolled on prospective clinical trials.