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Research Article Volume 17 Issue 1
Adjuvant systemic therapy in early breast cancer: from CMF to precision risk-adapted treatment
Adrian Hunis MD
Emeritus member of ASCO, ESMO, Honorary member of AMA, Argentina
Received: March 02, 2026 | Published: March 11, 2026
Citation: Hunis A. Adjuvant systemic therapy in early breast cancer: from CMF to precision risk-adapted treatment. J Cancer Prev Curr Res. 2026;17(1):9‒13. DOI: 10.15406/jcpcr.2026.17.00599
Abstract
Background: Adjuvant
systemic therapy has fundamentally altered the natural history of early breast
cancer. Beginning with Bonadonna’s CMF program, the curative principle of
micrometastatic eradication became clinically proven, and subsequent EBCTCG
meta-analyses quantified durable reductions in recurrence and mortality with
polychemotherapy.1–6
Methods: Evidence-based
narrative review of biological foundations (tumor kinetics and resistance),
landmark randomized trials, meta-analyses, and contemporary subtype-driven
strategies integrating chemotherapy, endocrine therapy, and modern
biologic/targeted agents.
Results: Anthracycline
and taxane-based regimens improved outcomes over earlier approaches, with
additional gains from dose-dense scheduling (validated by randomized trials).
HER2-directed therapy (trastuzumab ± pertuzumab) produced major reductions in
recurrence; response-adapted escalation with antibody–drug conjugates further
improved outcomes in residual disease. In HR-positive disease, endocrine
therapy is foundational and long-horizon, while genomic assays refine
chemotherapy selection. In TNBC, post-neoadjuvant capecitabine and
perioperative immunotherapy improve event-free outcomes. In selected high-risk
HR+/HER2− disease, CDK4/6 inhibition improves invasive disease-free survival;
and in germline BRCA1/2-mutated high-risk HER2− disease, adjuvant PARP
inhibition improves invasive DFS and overall survival.4–12,14–30
Conclusions: Modern
adjuvant care is biology-driven and risk-adapted. Integrating subtype, nodal
burden, genomic risk, and response to preoperative therapy maximizes cure while
minimizing toxicity and overtreatment. Future directions include ctDNA-based
minimal residual disease (MRD) strategies and adaptive escalation/de-escalation
trials.31–36
Keywords: systemic therapy, contemporary,cancer mortality
©2026 Hunis. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.