Chemotherapy in Carcinoma Breast: First generation regimen such as 6-monthly cycle of cyclophosphamide, methotrexate and 5-fluorouracil(CMF) will acheive a 25% reduction in the risk of relapse over a 10-12 year period. CMF is no longer considered adequate adjuvant chemotherapy. Modern regimens include an anthracycline (doxorubicin or epirubicin) and taxanes Effect of combining hormone and chemotherapy is additive although hormone therapy is staed after completion of chemotherapy to reduce side-effects. Most popular combinations were CMF & CAF (Cyclophosphamide, Adriamycin(Doxorubicin), and 5-flurouracil) In the united states, a combination of Adriamycin (doxorubicin) and cyclophosphide (AC) or Ac plus a taxane (docetaxel, paclitaxel) are likely to be used as polychemotherapy. For Her-2-positive breast cancer, adding trastuzumab to polychemotherapy is approved for use as a surgical adjuvant Anthracycline-containing combinations are significantly better than no treatment, single agent treatment or CMI Hormone Therapy in Breast carcinoma: Ovarian suppression or ablation: Bilateral oophorectomy Medically by LHRH agonist (Goserelin, Leuprolide) SERM: Tamoxifen & Raloxifen Aromatase inhibitors: Non-steroidal : Letrozole & Anastrozle Steroidal: Examestane Anti-estrogens: Fulvestrant Progestins: Megesterol & Medroxypregesterone acetate Ref: Sabiston 20th edition Pgno: 857