What is a common chemotherapy regimen for breast cancer?

Common Chemotherapy Regimens for Breast Cancer

For breast cancer treatment, anthracycline-taxane containing regimens are considered the optimal strategy for adjuvant chemotherapy, particularly for patients with high-risk disease. 1

Preferred Adjuvant Chemotherapy Regimens

• Anthracycline-Taxane Based Regimens:

  • Dose-dense AC (doxorubicin/cyclophosphamide) followed by paclitaxel every 2 weeks 1
  • AC (doxorubicin/cyclophosphamide) followed by weekly paclitaxel 1
  • Doxorubicin-cyclophosphamide × 4 → paclitaxel administered once per week 1

• Non-Anthracycline Based Regimens:

  • TC (docetaxel/cyclophosphamide) × 4 - recommended as an alternative to AC × 4 with improved disease-free survival and overall survival 1, 2
  • AC (doxorubicin/cyclophosphamide) 1

For HER2-Positive Breast Cancer

• Trastuzumab-Containing Regimens:
  • AC followed by T + concurrent trastuzumab (doxorubicin/cyclophosphamide followed by paclitaxel plus trastuzumab) 1
  • TCH (docetaxel, carboplatin, trastuzumab) 1
  • Trastuzumab should be given for 1 year with cardiac monitoring 1
  • Trastuzumab should not be given concurrently with anthracyclines due to cardiac toxicity 1, 3

Other Adjuvant Regimens

• FAC/CAF (fluorouracil/doxorubicin/cyclophosphamide) 1
• FEC/CEF (fluorouracil/epirubicin/cyclophosphamide) 1
• CMF (cyclophosphamide/methotrexate/fluorouracil) 1
• EC (epirubicin/cyclophosphamide) 1

Regimen Selection Based on Breast Cancer Subtype

• Luminal A tumors: Most require no chemotherapy except those with extensive nodal involvement 1
• Luminal B HER2-negative: Chemotherapy indications depend on individual risk of relapse 1
• Luminal B HER2-positive: Treated with chemotherapy, endocrine therapy, and trastuzumab 1
• HER2-positive (non-luminal): Should receive chemotherapy plus trastuzumab 1
• Triple-negative tumors: Benefit from adjuvant chemotherapy 1

Dosing Considerations

• Sequential use of anthracyclines and taxanes is recommended over concomitant administration 1
• Dose-dense schedules (with G-CSF support) should be considered particularly for highly proliferative tumors 1
• For patients at risk of cardiac complications, non-anthracycline taxane-based regimens like TC may be used 1, 2

Treatment Duration and Sequencing

• Standard adjuvant regimens typically consist of 4-8 cycles of chemotherapy 1
• Chemotherapy should be given before radiotherapy (except with CMF) 1
• Chemotherapy and tamoxifen used as adjuvant therapy should be given sequentially with tamoxifen after chemotherapy 1

Special Considerations

• Trastuzumab is recommended for all patients with HER2-positive, node-positive breast cancer and for patients with HER2-positive, node-negative breast cancer >1 cm 1
• Retrospective evidence suggests anthracycline-based regimens may be superior to non-anthracycline regimens in HER2-positive tumors 1
• Randomized trials show addition of taxanes to anthracycline-based chemotherapy provides improved outcomes 1
• TC (docetaxel/cyclophosphamide) has shown superior disease-free survival compared to AC in clinical trials 2

Common Side Effects and Management

• Anthracycline regimens: Risk of cardiotoxicity, monitor cardiac function 3
• Taxane regimens: Neuropathy, myalgia, arthralgia 2
• Febrile neutropenia: More common with docetaxel-containing regimens 4, 5
• Consider G-CSF support for patients at high risk of neutropenia (advanced age, poor performance status) 6

Metastatic Setting

• Single-agent chemotherapy is generally preferred over combination therapy for better quality of life in metastatic disease 1
• Common options include capecitabine, vinorelbine, and platinum agents 1, 7
• For hormone receptor-positive metastatic disease, endocrine therapy is preferred first-line unless there is rapidly progressive visceral disease 8