Taxanes — Taxanes are among the most active agents for metastatic breast cancer – Docetaxel, Paclitaxel, NabPaclitaxel. Anthracyclines – Doxorubicin, Epirubicin,

Taxanes — Taxanes are among the most active agents for metastatic breast cancer – Docetaxel, Paclitaxel, NabPaclitaxel.

Anthracyclines – Doxorubicin, Epirubicin, Caelyx.

Capecitabine / 5 FU

Eribulin

Vinorelbine

Gemcitabine

Ixabepilone

Etoposide

Cyclophosphamide

Methotrexate

Platinum agents

Combination Chemotherapy

High Dose Chemotherapy and Stem Cell Transplant – no benefit.

Common Adjuvant Regimens

First Generation → Second

Generation → Third Generation

CMF*6 → CAF*6, CEF*6

CMF*6 → FAC*6 → TAC*6

CE(50)F*6 → CE(100)F*6 → FEC*3→D*3

AC*4 →AC*4→Txl*4

q3wk →Dose Dense (CA*4→Txl*4

q2wk)

AC*4 → TC*4

20% 20%

RANDOMIZE

Doxorubicin 60 mg/m2 IV Day 1

Cyclophosphamide 600 mg/m2 IV Day 1

Every 21 days x 4 cycles

Docetaxel 75 mg/m2 IV Day 1

Cyclophosphamide 600 mg/m2 IV Day 1

Every 21 days x 4 cycles

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2nd Generation Adjuvant Chemo Trials

First Generation → Second

Generation → Third Generation

CMF*6 → CAF*6, CEF*6

CMF*6 → FAC*6 → TAC*6

CE(50)F*6 → CE(100)F*6 → FEC*3→D*3

AC*4 →AC*4→Txl*4

q3wk →Dose Dense (CA*4→Txl*4

q2wk)

AC*4 → TC*4

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What’s the Goal?

• Select patients who will require systemic therapy

• Find predictive factors (either before or early in treatment) that allow for accurate tailoring of therapy

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