Adjuvant systemic therapy of early stage breast cancer

William J. Gradishar1

(1) Division of Hematology/Oncology, The Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 850, 60611 Chicago, IL, USA


Opinion statement Adjuvant chemotherapy reduces the risk of recurrence and mortality in patients with early stage breast cancer. Anthracycline-based regimens are the most widely used standard in the United States. The inclusion of the taxanes into adjuvant chemotherapy programs offers an improvement in disease-free survival rates and probably overall survival rates compared to an anthracycline-based regimen alone. Although adjuvant chemotherapy is effective in all age groups, the magnitude of benefit is greatest in younger premenopausal patients. Treatment decisions need to be individualized. Dose-dense chemotherapy approaches are promising and can be considered an option for patients with early stage breast cancer. Adjuvant tamoxifen therapy should be administered for 5 years in patients with hormone receptor-positive breast cancer. Adjuvant tamoxifen should be administered after the completion of adjuvant chemotherapy. Data from the ATAC (Arimidex, tamoxifen, alone, or in combination) trial provide a compelling argument for choosing anastrozole as adjuvant endocrine therapy in postmenopausal women with hormone receptor-positive early stage breast cancer. Long-term follow-up of patients is necessary to determine the effects of chronic aromatase inhibitor treatment on bone density, cognitive function, and other endpoints.