What are the second-generation regimens for the treatment of stage I, IIA, IIB, or IIIA (T3N1M0) HER2/neu-negative breast cancer?

Updated: Apr 23, 2020
  • Author: Joseph A Sparano, MD; Chief Editor: John V Kiluk, MD, FACS  more...
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Answer

Second-generation regimens

Second-generation regimens have been shown to be more effective than other regimens with which they were compared, which in some studies included first-generation regimens such as CMF. Some of these regimens may be appropriate for patients who desire less prolonged regimens. There is geographic variation in the use of these regimens: DC and AC-P are more commonly used in the United States, and epirubicin-containing regimens are more commonly used in Europe. The regimens are as follows:

  • FAC: 5-FU 500 mg/m2 IV on days 1 and 8 or days 1 and 4 plus  doxorubicin 50 mg/m2 IV on day 1 plus  cyclophosphamide 500 mg/m2 IV on day 1 every 3 wk for six cycles (more effective than CMF) [17] or

  • CEF: Cyclophosphamide 75 mg/m2 PO on days 1-14 plus epirubicin 60 mg/m2 on days 1 and 8 plus  5-FU 500 mg/m2 IV on days 1 and 8 every 4 wk for six cycles (more toxic than other alternatives in this category; with cotrimoxazole support) or

  • Dose-dense AC-P: Doxorubicin 60 mg/m2 IV on day 1 plus  cyclophosphamide 600 mg/m2 IV on day 1 every 2 wk for four cycles, followed by paclitaxel 175 mg/m2 by 3-h IV infusion on day 1 every 2 wk for four cycles with colony-stimulating factor (CSF) support (more effective than the 3-wk schedule in ER/PR-negative disease) [8] or

  • TC: Docetaxel 75 mg/m2 IV on day 1 plus  cyclophosphamide 600 mg/m2 IV on day 1 every 3 wk for four cycles (more effective than AC) [18]


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