TABLE I.

Recommendations for adjuvant chemotherapy

In patients who can tolerate it, use of a regimen containing anthracycline–taxane is considered the optimal strategy for adjuvant chemotherapy, particularly in patients deemed to be at high risk. For patients in whom a taxane is contraindicated, an optimal-dose anthracycline regimen (doxorubicin ≥240 mg/m2 or epirubicin ≥360 mg/m2) is recommended. The addition of gemcitabine or capecitabine to an anthracycline–taxane regimen is not recommended for adjuvant chemotherapy. In patients more than 65 years of age, capecitabine is not recommended as an adjuvant chemotherapy option in lieu of adjuvant doxorubicin–cyclophosphamide or cyclophosphamide–methotrexate–5-fluorouracil (with oral cyclophosphamide). For patients in whom anthracycline–taxane is contraindicated, cyclophosphamide–methotrexate–5-fluorouracil (with oral cyclophosphamide) is an acceptable chemotherapy regimen. These adjuvant chemotherapy regimens can be used for patients with early-stage breast cancer: 5-Fluorouracil–epirubicin–cyclophosphamide × 3, followed by docetaxel × 3 (superior to 5-fluorouracil–epirubicin–cyclophosphamide × 6) Doxorubicin–cyclophosphamide × 4, followed by docetaxel × 4 (superior to doxorubicin–cyclophosphamide × 4) Docetaxel–doxorubicin–cyclophosphamide × 6 (superior to 5-fluorouracil–doxorubicin–cyclophosphamide × 6) Doxorubicin–cyclophosphamide × 4, followed by weekly paclitaxel Dose-dense, dose-intense epirubicin–cyclophosphamide, followed by paclitaxel Dose-dense doxorubicin–cyclophosphamide, followed by paclitaxel every 2 weeks Docetaxel–cyclophosphamide is an adjuvant regimen that can be used when anthracycline is not preferred.