Chemotherapy Regimens in the Adjuvant and Advanced Disease Settings

In both early and advanced breast cancer, chemotherapy forms a vital component of most treatment algorithms, despite the arrival of targeted agents. The number of agents with meaningful activity is large, particularly in advanced disease, and the choice of regimen must take into account predicted efficacy and toxicity in the context of prognostic factors and patient wishes. Several chemotherapy regimens may exist for a given clinical situation, and selecting an optimal treatment can be difficult, despite progress in the understanding of molecular subtypes and relevant mutations. In early-stage disease, the superiority of one regimen over another must be considered in the context of the absolute risk of relapse. Additionally, luminal subtypes may have lower overall chemosensitivity, which can influence choice. In advanced disease, tolerability plays a greater role. The use of tumour subtype or genomic markers such as BRCA mutation to assist in selecting optimal agents is promising but remains investigational. This chapter will consider the range of chemotherapy options available and offer evidence-based suggestions for current management.