Table 10.
Commonly used adjuvant/neoadjuvant treatment options for breast cancera
| 1 Adjuvant/neoadjuvant therapy for HER2-negative breast cancer | |
| TAC regimen | |
| Docetaxel 75 mg/m2 iv on day 1 | |
| Doxorubicin 50 mg/m2 iv on day 1 | |
| Cyclophosphamide 500 mg/m2 iv on day 1 | |
| 21 d/cycle, 6 cycles in total | |
| (All cycles are supported with G-CSF/PEG-rhG-CSF) | |
| Dose-intensive AC/EC→P (once every 2 weeks) | |
| Doxorubicin 60 mg/m2 iv on day 1 | |
| or epirubicin 90–100 mg/m2 iv on day 1 | |
| Cyclophosphamide 600 mg/m2 iv on day 1 | |
| 14 d/cycle, 4 cycles in total | |
| Sequentially with | |
| Paclitaxel 175 mg/m2 iv 3 h on day 1:14 d/cycle, 4 cycles in total | |
| (All cycles are supported with G-CSF/PEG-rhG-CSF) | |
| Dose-dense AC/EC→P (once every week) | |
| Doxorubicin 60 mg/m2 iv on day 1 | |
| or epirubicin 90–100 mg/m2 iv on day 1 | |
| Cyclophosphamide 600 mg/m2 iv on day 1 | |
| 14 d/cycle, 4 cycles in total (supported with G-CSF/PEG-rhG-CSF) | |
| Sequentially with | |
| Paclitaxel 80 mg/m2 iv 1 h on day 1: once a week, 12 weeks in total | |
| AC/EC→P/T regimen | |
| Doxorubicin 60 mg/m2 iv on day 1 | |
| or epirubicin 90–100 mg/m2 iv on day 1 | |
| Cyclophosphamide 600 mg/m2 iv on day 1 | |
| 21 d/cycle, 4 cycles in total | |
| Sequentially with | |
| Paclitaxel 80 mg/m2 iv 1 h on day 1: once a week, 12 weeks in total | |
| Or docetaxel 100 mg/m2 iv on day 1:21 d/cycle, 4 cycles in total | |
| TC regimen (for adjuvant therapy) | |
| Docetaxel 75 mg/m2 iv on day 1 | |
| Cyclophosphamide 600 mg/m2 iv on day 1 | |
| 21 d/cycle, 4–6 cycles in total | |
| AC regimen | |
| Doxorubicin 60 mg/m2 iv on day 1 | |
| Cyclophosphamide 600 mg/m2 iv on day 1 | |
| 21 d/cycle, 4 cycles in total | |
| EC regimen | |
| Epirubicin 100 mg/m2 iv on day 1 | |
| Cyclophosphamide 830 mg/m2 iv on day 1 | |
| 21 d/cycle, 4 cycles in total | |
| PCb regimen | |
| Paclitaxel 80 mg/m2, on days 1, 8, 15 | |
| Carboplatin area under curve (AUC) = 6 on day 1, or AUC = 2 on days 1, 8, 15 | |
| 21 d/cycle, 4–6 cycles in total | |
| TCb regimen | |
| Docetaxel 75 mg/m2 on day 1 | |
| Carboplatin AUC = 6 on day 1 | |
| 21 d/cycle, 4–6 cycles in total | |
| Intensive adjuvant therapy | |
| [1] XT→XEC regimen (for triple-negative breast cancer) | |
| Docetaxel 75 mg/m2 iv on day 1 | |
| Capecitabine 1,000 mg/m2 po bid on days 1-14 | |
| 21 d/cycle, 4 cycles in total | |
| Sequentially with | |
| Epirubicin 75 mg/m2 iv on day 1 | |
| Cyclophosphamide 600 mg/m2 iv on day 1 | |
| Capecitabine 1,000 mg/m2 po bid on days 1-14 | |
| 21 d/cycle, 4 cycles in total | |
| [2] Dose-intensive X after standard chemotherapy (for triple-negative breast cancer) | |
| Capecitabine 650 mg/m2 po bid, orally for 1 year continuously | |
| [3] Dose-intensive X after neoadjuvant does not reach pCR (for triple-negative breast cancer and lymph node residual–positive ER-positive/HER2-negative breast cancer) | |
| Capecitabine 1,250 mg/m2 po bid, on days 1-14, for a total of 8 cycles | |
| [4] Olaparib enhancement (for pathogenic/suspected pathogenic gBRCA mutation high-risk breast cancer that does not reach indication for adjuvant therapy yet) | |
| Olaparib 300 mg po bid, orally for 1 year | |
| Neoadjuvant endocrine therapy for ER-positive/HER2-negative patients: postmenopausal patients usually use AI for neoadjuvant endocrine therapy; premenopausal patients should not be routinely subjected to neoadjuvant endocrine therapy unless they enter a clinical study or have contraindications to chemotherapy (OFS+AI/fulvestrant is optional). | |
| 2. Adjuvant/neoadjuvant therapy for HER2-positive breast cancer | |
| AC/EC→PH | |
| Doxorubicin 60 mg/m2 iv on day 1 | |
| or epirubicin 90–100 mg/m2 iv on day 1 | |
| Cyclophosphamide 600 mg/m2 iv on day 1 | |
| 21 d/cycle, 4 cycles in total | |
| Sequentially with | |
| Paclitaxel 80 mg/m2 iv 1 h day 1 | |
| Trastuzumab 2 mg/kg (with a first dose of 4 mg/kg) on day 1 | |
| Once a week, for a total of 21 weeks | |
| Then trastuzumab 6 mg/kg, once every 3 weeks for 1 year | |
| Monitor cardiac function once every 3 months | |
| Dose-dense AC/EC→PH regimen | |
| Doxorubicin 60 mg/m2 iv on day 1 | |
| or epirubicin 90–100 mg/m2 iv on day 1 | |
| Cyclophosphamide 600 mg/m2 iv on day 1 | |
| 14 d/cycle, 4 cycles in total | |
| Sequentially with | |
| Paclitaxel 175 mg/m2 iv 3 h on day 1, 14 d/cycle, 4 cycles in total | |
| (All cycles are supported with G-CSF/PEG-rhG-CSF) | |
| At the same time, trastuzumab is given as a first dose of 4 mg/kg and then 2 mg/kg once a week for 1 year | |
| Trastuzumab can also be given after the end of paclitaxel, with a first dose of 8 mg/kg followed by 6 mg/kg once every 3 weeks for 1 year. | |
| Cardiac function should be monitored at baseline and months 3, 6, and 9 | |
| AC/EC→TH regimen | |
| Doxorubicin 60 mg/m2 iv on day 1 | |
| or epirubicin 90–100 mg/m2 iv on day 1 | |
| Cyclophosphamide 600 mg/m2 iv on day 1 | |
| 21 d/cycle, 4 cycles in total | |
| Sequentially with | |
| Docetaxel 100 mg/m2 iv on day 1 | |
| Trastuzumab 2 mg/kg (with a first dose of 4 mg/kg) on days 1, 8, and 15, | |
| 21 d/cycle, 4 cycles in total, and then trastuzumab at 6 mg/kg once every 3 weeks for 1 year | |
| Cardiac function should be examined once every 3 months | |
| TCbH regimen | |
| Docetaxel 75 mg/m2 iv on day 1 | |
| Carboplatin AUC =6 iv on day 1 | |
| Trastuzumab 6 mg/kg (with a first dose of 8 mg/kg) on day 1 | |
| 21 d/cycle, 6 cycles in total | |
| Then trastuzumab 6 mg/kg once every 3 weeks for 1 year | |
| Cardiac function should be examined once every 3 months | |
| AC/EC→THP regimen | |
| Doxorubicin 60 mg/m2 iv on day 1 | |
| or epirubicin 90–100 mg/m2 iv on day 1 | |
| Cyclophosphamide 600 mg/m2 iv on day 1 | |
| 21 d/cycle, 4 cycles in total | |
| Sequentially with | |
| Docetaxel 75-100 mg/m2 iv on day 1 | |
| or paclitaxel 80 mg/m2 iv 1 h on days 1, 8, and 15 | |
| Trastuzumab 6 mg/kg (with a first dose of 8 mg/kg) on day 1 | |
| Pertuzumab 420 mg iv (with a first dose of 840 mg) on day 1 | |
| 21 d/cycle, 4 cycles in total | |
| Then trastuzumab 6 mg/kg + pertuzumab 420 mg once every 3 weeks for 1 year | |
| Cardiac function should be examined once every 3 months | |
| Dose-dense AC/EC→THP regimen | |
| Doxorubicin 60 mg/m2 iv on day 1 | |
| or epirubicin 90–100 mg/m2 iv on day 1 | |
| Cyclophosphamide 600 mg/m2 iv on day 1 | |
| 14 d/cycle, 4 cycles in total (supported by G-CSF/PEG-rhG-CSF) | |
| Sequentially with | |
| Docetaxel 75-100 mg/m2 iv on day 1 | |
| or paclitaxel 80 mg/m2 iv 1 h on days 1, 8, and 15 | |
| Trastuzumab 6 mg/kg (with a first dose of 8 mg/kg) day 1 | |
| Pertuzumab 420 mg (with a first dose of 840 mg) iv on day 1 | |
| 21 d/cycle, 4 cycles in total | |
| Then trastuzumab 6 mg/kg + pertuzumab 420 mg once every 3 weeks for 1 year | |
| Cardiac function should be examined once every 3 months | |
| TCbHP regimen | |
| Docetaxel 75 mg/m2 iv on day 1 | |
| Carboplatin AUC =6 iv on day 1 | |
| Trastuzumab 6 mg/kg (with a first dose of 8 mg/kg) day 1 | |
| Pertuzumab 420 mg (with a first dose of 840 mg) iv on day 1 | |
| 21 d/cycle, 6 cycles in total | |
| Then trastuzumab 6 mg/kg + pertuzumab 420 mg once every 3 weeks for 1 year | |
| Cardiac function should be examined once every 3 months | |
| wTH regimen (for adjuvant therapy) | |
| Paclitaxel 80 mg/m2 iv 1 h day 1 | |
| Trastuzumab 2 mg/kg (with a first dose of 4 mg/kg) iv on day 1 | |
| Once a week, for a total of 12 weeks | |
| Then trastuzumab 6 mg/kg once every 3 weeks for 1 year | |
| Cardiac function should be examined once every 3 months | |
| TC+H regimen (for adjuvant therapy) | |
| Docetaxel 75 mg/m2 iv on day 1 | |
| Cyclophosphamide 600 mg/m2 iv on day 1 | |
| Trastuzumab 6 mg/kg (with a first dose of 8 mg/kg) day 1 | |
| 21 d/cycle, 4 cycles in total | |
| Then followed by trastuzumab 6 mg/kg once every 3 weeks for 1 year | |
| Cardiac function should be examined once every 3 months | |
| Adjuvant intensive therapy regimen (for high-risk HER-positive breast cancer, especially ER+ patients) | |
| Neratinib 240 mg po qd for one year after completion of trastuzumab-containing therapy |
a In the above adjuvant therapy, nab-paclitaxel can be tried to replace paclitaxel or docetaxel when medically necessary (e.g., reducing allergic reactions, etc.), but with a weekly therapeutic dose not exceeding 125 mg/m2