Adjuvant chemotherapy for breast cancer

Background: Over the past three decades significant advances have been made in the adjuvant treatment of breast cancer. Despite an increasing incidence of breast cancer, mortality has undergone a gradual decline. This decline in mortality is likely due to numerous factors, including earlier stage at diagnosis, advances in local therapy, and advances in the systemic treatment of breast cancer. This article reviews the background and implementation of the current use of chemotherapy in the adjuvant setting. Methods: The authors reviewed data from published randomized trials and meta-analyses to analyze the rationale behind the current use of systemic chemotherapy in the adjuvant setting. Recent data regarding the use of taxanes as well as neoadjuvant chemotherapy is also presented. Conclusions: Numerous randomized trials and the data obtained from the Early Breast Cancer Trialists' Collaborative Group confirm that both pre- and postmenopausal women benefit from adjuvant chemotherapy. Anthracycline-containing regimens are superior to those not containing anthracycline, and should be incorporated into the care of most patients with operable breast cancer. The decision to use chemotherapy should be based upon the potential benefits and theoretical risks associated with therapy and individualized for each patient.