Adjuvant chemotherapy for hormone receptor-positive or negative, HER2-negative breast cancer
- Harold Burstein, MD, PhD
Harold Burstein, MD, PhD
- Associate Professor of Medicine
- Harvard Medical School
- Section Editor
- Daniel F Hayes, MD
Daniel F Hayes, MD
- Section Editor — Breast Cancer
- Professor of Medicine
- University of Michigan School of Medicine
- Deputy Editor
- Don S Dizon, MD, FACP
Don S Dizon, MD, FACP
- Deputy Editor — Oncology and Palliative Care
- Medical Gynecologic Oncology
- Massachusetts General Hospital
- Gillette Center for Women's Cancers
- Associate Professor, Medicine & Obstetrics and Gynecology
- Warren Alpert Medical School of Brown University
Breast cancer is a global health problem and the most common cancer in both the developed and developing world. The lifetime probability of developing breast cancer is one in six overall (one in eight for invasive disease). It is a heterogeneous, phenotypically diverse disease composed of several biologic subtypes that have distinct behaviors and responses to therapy.
The use of adjuvant systemic therapy is responsible, at least in part, for the reduction in cause-specific mortality from breast cancer seen in almost every Western nation . Whether tumors are estrogen (ER) or progesterone (PR) receptor-positive or negative, the choice of agents used as adjuvant chemotherapy (ie, the administration of cytotoxic treatment following primary surgery) is the same. Treatment directed against the human epidermal growth factor receptor 2 (HER2) is incorporated for those patients with HER2 overexpression. (See "Adjuvant medical therapy for HER2-positive breast cancer".)
This topic will discuss the role of chemotherapy in the adjuvant treatment of early-stage breast cancer, how to estimate the benefit and risk of chemotherapy, the indications for adjuvant chemotherapy, and the dosing and timing of treatment. Adjuvant medical therapy for patients with early stage HER2-positive breast cancer, adjuvant endocrine therapy, the treatment of male breast cancer, and breast cancer in older patients are discussed separately:
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- INDICATIONS FOR TREATMENT
- PROGNOSTIC FACTORS
- ESTIMATING RISKS AND BENEFITS
- Genomic profiling
- Benefit-risk calculators
- ADJUVANT CHEMOTHERAPY
- The Early Breast Cancer Trialists' Collaborative Group (EBCTCG) Meta-Analysis
- - 2011 EBCTCG Meta-analysis
- Adjvant chemotherapy versus no further treatment
- Anthracycline-based therapy versus CMF
- - 2012 EBCTCG meta-analysis
- - Importance of chemotherapy schedule
- - Duration
- Non-anthracycline-based regimens
- High dose chemotherapy with autologous hematopoietic stem cell transplant
- SEQUENCING CHEMOTHERAPY AND RADIATION
- SPECIAL POPULATIONS
- Older women
- Male breast cancer
- Breast cancer in pregnancy
- Patients with cardiac risk factors
- Obese women
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS