Dose-dense and sequential strategies in adjuvant breast cancer therapy

Several attempts have been made to improve the survival rates of breast can cer patients. The benefit of adjuvant chemotherapy was clearly shown, but t he absolute difference of 2% to 11% in overall survival, depending on the p atient group, is disappointingly small. In particular high-risk patients, s uch as those with greater than or equal to 10 involved lymph nodes, extraca psular spread, or vascular invasion, still have an excessive risk of recurr ence even after standard adjuvant chemotherapy. To increase the survival ra tes after adjuvant therapy, new chemotherapeutic agents and new strategies of application are currently being evaluated in clinical trials. Chemothera py with cyclophosphamide (Cytoxan, Neosar), methotrexate, and fluorouracil (CMF) seems to be safe and effective in patients, with breast cancer. In ad dition, in metastatic patients, dose-intensified chemotherapy is being inve stigated. The introduction of epirubicin (Ellence), an agent less cardiotox ic and equally active compared to doxorubicin, enabled the escalation of an thracyclines in adjuvant therapy without serious cardiotoxic effects. The c ombination of dose-intensified chemotherapy and sequential application in t he treatment of breast cancer is reviewed.