Lawrence N. Shulman, MD, chief of staff, senior vice president for medical affairs, director, Center for Global Cancer Medicine, director, Department of Regional Strategy and Development, chief, Division of General Oncology, Dana-Farber Cancer Institute, discusses chemotherapy choices for patients with adjuvant breast cancer.

Shulman says data have shown that other taxanes are no more efficacious and are, in fact, more toxic than paclitaxel, including nab-paclitaxel. Shulman believes that paclitaxel is the best taxane to use in this group of patients even though others may argue that docetaxel is more effective. However, Shulman says there is no good evidence to support this claim and physicians are ‘stuck' using combination chemotherapy.

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Dr. Shulman on Chemotherapy in Adjuvant Breast Cancer

Lawrence N. Shulman, MD, chief of staff, senior vice president for medical affairs, director, Center for Global Cancer Medicine, director, Department of Regional Strategy and Development, chief, Division of General Oncology, Dana-Farber Cancer Institute, discusses the results of the CALGB 40101 trial.

The trial, which compared the efficacy of adjuvant cyclophosphamide (AC) and doxorubicin versus paclitaxel, showed that paclitaxel is not equivalent to the AC combination, Shulman says.

Shulman says all statistical analyses showed that the AC combination is still the most effective treatment and that combination chemotherapy is essential. Unfortunately, Shulman says, AC is more toxic. Although the AC arm of the study had more occurrences of leukemia and cardiac death, it is still a better regimen overall.

Lawrence N. Shulman, MD

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Dr. Shulman on Chemotherapy in Adjuvant Breast Cancer

Dr. Shulman on the CALGB 40101 Trial