Adjuvant Chemotherapy in Early Breast Cancer

The term early breast cancer (EBC) encompasses a heterogeneous group of breast cancers whose behaviour varies considerably based on the clinical characteristics and tumour biology. For the same reason, decision on adjuvant chemotherapy is often difficult for the clinician. In luminal-like tumours, gene expression profiling is increasingly used to aid in deciding on adjuvant therapy. In HER2-positive tumours, all women with a tumour size of >1 cm are candidates for adjuvant chemotherapy, AC-TH and TCH being the preferred schedules. In smaller tumours, single-agent paclitaxel may be adequate with standard-schedule trastuzumab. The duration of trastuzumab therapy is preferably 12 months. Adjuvant chemotherapy in TNBC is indicated in all women with a tumour size of >5 mm. Data are emerging that smaller node-negative TNBC patients may be offered non-anthracycline-based chemotherapy (TC × 6), although not incorporated into any guidelines. In a resource-starved setting like ours, we would continue to use clinico-pathological factors to base our decisions on adjuvant therapy in a large majority.