Adjuvant systemic therapy for breast cancer

The continued research efforts in the field of breast cancer adjuvant therapy are translating into a better understanding of the real, but still modest, impact on patient outcome. Recent publications are focusing either on secondary leukemias or on secondary solid tumors, which are associated with the use of adjuvant chemotherapy or adjuvant tamoxifen, respectively. These attempts at an improved risk-benefit assessment of classic adjuvant treatment for breast cancer are to be encouraged. In parallel, there is an urgent need for innovative treatment approaches that have to be carefully evaluated through prospective randomized clinical trials. These include increasing chemotherapy dose intensity, changing timing or scheduling of drug administration, or moving new active agents, such as the taxoid compounds, to the adjuvant setting. Major efforts still need to be done in using new molecular markers of tumor aggressiveness for an improved assessment of a patientʼs individual risk of relapse. Finally, increasing attention is being paid to optimal therapy for elderly patients.