If Chemotherapy Is Indicated, Give the Optimal Regimen!

suggests that chemotherapy should be given at maximum dosages at minimum intervals. Combination chemotherapy, which always has to make compromises regarding the doses of each drug and treatment intervals due to acute as well as cumulative toxicities, does therefore not comply with this theory. Sequential application of monotherapies, however, allows very high single agent doses and dose-dense treatment intervals. Such dose-dense regimens as well as a meta-analysis [7] have shown higher efficacy in comparison to conventionally dosed chemotherapy, but they did not establish a new standard of care, because the published trials reported controversial results. The design of the individual dose-dense trials shows important differences regarding number of cycles, types of drugs and total dose. In addition, some trials are reported as dosedense, but present a mixture of dose-dense and conventional schedules. Also the risk profile of the recruited patients differs remarkably between the trials with a median range of tumor positive lymph nodes between 1 and 8. Considering these differences explains why we have negative and positive trials. Although subgroup analyses are considered as hypothesis generating only, they may have consequences for clinical routine. Only (intense) dose-dense trials, which recruited exclusively high-risk patients, showed a significant benefit for ER+ and ER– patients [8, 9]. In this issue of Breast Care results and therapeutic options of dose-dense-trials in the adjuvant, neoadjuvant, and metastatic situation are discussed.