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Advances in Adjuvant and Primary Systemic Therapy of Early Breast Cancer

The BCIRG (Breast Cancer International Research Group) 006 and FinHER (Finland Herceptin) trials confirm the results of recently published randomized phase III studies that the addition of trastuzumab to standard chemotherapy improves disease-free survival of patients with HER2-positive breast cancer. Moreover, they included 2 different strategies that seem to reduce trastuzumab-associated cardiotoxicity. However, data are preliminary. Dose-dense chemotherapy can be offered to patients with high-risk HER2-negative breast cancer, based on an updated analysis of the CALBG (Cancer and Acute Leukemia Group B) C9741 trial. Nevertheless, sequential FEC (5-fluorouracil/epirubicin/cyclophosphamide)taxane regimens should be considered as adjuvant chemotherapy for node-positive breast cancer, since FEC and docetaxel have been shown to be superior to a standard FEC therapy. Using paclitaxel as taxane compound is an alternative strategy that needs to be re-evaluated after a longer follow-up period. The combination of docetaxel and cyclophosphamide is restricted to patients in whom anthracyclines are contraindicated and who are at intermediate risk of disease recurrence. An extended adjuvant therapy with letrozole is an option for patients who have completed 5 years of tamoxifen. It can be assumed that patients benefit from letrozole even after a longer period of time since the tamoxifen therapy.