Research advances in breast cancer chemotherapy have been the focus of clinicians in the field of breast cancer. A number of large studies presented at the American Society of Clinical Oncology (ASCO) Annual Meeting, European Cancer Congress (ECCO) and San Antonio Breast Cancer Congress (SABCS) 2015 may provide some benefit for future clinical decision making, and are categorized and excerpted below. Advances in chemotherapy for Luminal A breast cancer Luminal A breast cancer is one of the common subtypes of breast cancer characterized by high ER/PR expression and low HER2/Ki67 expression. Compared with other histological subtypes, patients with Luminal A breast cancer have relatively the best prognosis, but have a lower response rate to chemotherapy. Patients with postmenopausal Luminal A invasive breast cancer do not benefit from cyclophosphamide chemotherapy The results of the 10-year progression-free survival of patients enrolled in the DBCG77B study, published at SABCS, further confirm that patients with postmenopausal Luminal A invasive breast cancer do not benefit from cyclophosphamide chemotherapy. Between 1977 and 1983, 1146 postmenopausal breast cancer patients with tumor diameters >125 px or lymph node metastases were randomized to single-agent oral cyclophosphamide or CMF regimens or levamisole or no drug therapy. 709 patients who completed immunohistochemical analysis did not benefit from cyclophosphamide-based chemotherapy in patients with Luminal A according to IHC classification ( HR=1.07, P=0.86), whereas non-Luminal A breast cancer benefited significantly (HR=0.50, P<0.001< span="">). Adjuvant capecitabine added to standard regimen improves patient survival in patients with residual lesions despite neoadjuvant chemotherapy Encouraging results of the CREATE-X/JBCRG-04 Japan-Korea combined phase III study were reported at SABCS. The study enrolled 910 patients with HER2-negative breast cancer who did not reach pathologic complete remission (pCR) with neoadjuvant chemotherapy with anthracycline, paclitaxel, or a combination of both between 2007 and 2012 and were randomized to standard 8 cycles of capecitabine after surgery. The estimated 5-year DFS was 74.1% vs. 67.7% (HR=0.70; P=0.005). In addition, the 2-year OS rate was 94.0% vs 89.2% in the add-on capecitabine group versus the control group, respectively; the estimated 5-year OS rate was 89.2% vs 83.9% (HR = 0.60; P < 0.01). Grade 3/4 toxicity was manageable in both groups. The investigators speculate that much of the benefit from capecitabine may be due to the lack of cross-resistance between it and anthracyclines or paclitaxel. Therefore, in neoadjuvant chemotherapy regimens (paclitaxel and/or anthracyclines) where pCR is used as a guide, the subsequent addition of capecitabine significantly improves DFS in patients who do not achieve pCR. II. Progress in chemotherapy for triple-negative breast cancer (TNBC) The addition of carboplatin to standard chemotherapy significantly increases patient pCR rates in both early-stage and stage II-III TNBC patients In TNBC patients, the The GeparSixto study reported at SABCS included 585 patients with early-stage TNBC or HER2-positive patients, all of whom were given paclitaxel in combination with liposomal adriamycin standard weekly regimen of neoadjuvant chemotherapy for a total of 18 weeks and one of the following targeted agents until surgery: bevacizumab monotherapy (Bev, TNBC patients), trastuzumab, and lapatinib (HER2-positive patients). The primary endpoint was the pCR rate with or without once-weekly carboplatin treatment given at a 1:1 ratio at randomization. The results showed a significantly higher pCR rate in the carboplatin group (n=295) than in the control group (n=293) in TNBC patients (43.7% vs 36.9%, P<0.05< span="">); whereas the pCR rate in HER2-positive patients was not significantly different between the two groups (36.8% vs 32.8%). The CALGB40603 study included 443 patients with stage II-III TNBC, all of whom received standard chemotherapy (paclitaxel 80 mg/m2 once weekly) for 12 weeks, followed by a combination of adriamycin and cyclophosphamide (once every 2 weeks × 4 cycles). Patients were randomized to receive either standard chemotherapy or one of the following combinations: carboplatin (every 3 weeks x 4 cycles), Bev (10 mg/kg every 2 weeks x 9 cycles), or carboplatin + Bev. The results suggested a significant increase in the pCR rate for breast cancer with the standard paclitaxel-based regimen in combination with carboplatin (60% vs. 44%, P=0.0018); the pCR rate with or without Bev was 59% and 48%, respectively. The pCR rates were 59% and 48% with or without Bev, respectively (P=0.0089). In addition, the combination of carboplatin also resulted in a significant increase in breast and axillary pCR rates (54% vs. 41%, P = 0.0029). Carboplatin + nano-paclitaxel regimen was superior to gemcitabine + nano-paclitaxel regimen for TNBC The ADAPT TN study included 443 patients with TNBC (staging cT1c-T4c, cN0/+) and compared the pCR rates of carboplatin + nano-paclitaxel (Carbo/Nab-Pac) or gemcitabine + nano-paclitaxel (Gem/Nab-Pac) neoadjuvant chemotherapy for 12 weeks. The pCR rate was 28.7% for patients in the Gem/Nab-Pac group and 45.9% for patients in the Carbo/Nab-Pac group; the frequency of drug dose downregulation was significantly higher in the Gem/Nab-Pac group than in the Carbo/Nab-Pac group (20.6% vs. 11.9%). The study suggests that the carboplatin + nanopaclitaxel regimen may be a better treatment option with higher pCR rates and lower drug reduction rates than gemcitabine + nanopaclitaxel. Docetaxel + carboplatin + Bev (TCV) combination neoadjuvant therapy for TNBC is effective in improving patient pCR and survival prognosis A phase II clinical study reported at ECCO included 24 patients with stage II-III TNBC and explored the effectiveness of the TCV regimen with pCR as the primary endpoint. Patients received combination chemotherapy with docetaxel 75 mg/m2, carboplatin AUC=6 and Bev 15 mg/kg (once every 3 weeks x 6 cycles) followed by surgery. Results showed that 79.2% (19/24 patients) completed 6 cycles of chemotherapy without disease progression during neoadjuvant chemotherapy; patients had a 45.8% pCR rate in the breast and axilla. 20.8% (5/24 patients) underwent mastectomy; and 79.17% underwent conservative surgery after neoadjuvant chemotherapy. After a median follow-up of 25 months, PFS was 87.5% (21/24 patients), one patient survived local recurrence without disease after treatment, and 8.3% (2/24 patients) discontinued the trial due to disease progression. The study concluded that the combination of TCV for TNBC patients resulted in satisfactory pCR rates and survival prognosis, allowing more than 2/3 of patients to be subsequently treated with conservative surgery with manageable hematologic toxicity. III. Overall analysis The paclitaxel regimen is superior to nanopaclitaxel and isapirone for the treatment of advanced breast cancer, and the weekly paclitaxel regimen remains the microtubule inhibitor regimen of choice for the first-line treatment of advanced breast cancer The final results of the CALGB 40502/NCCTG N063H study conducted in chemotherapy primed patients with advanced breast cancer were published in JCO 2015. The study included 799 patients ≥18 years of age with stage IIIC or IV breast cancer who had not received chemotherapy, with 66% ER/PR positive and HER2 negative and 26% TNBC. Patients were randomized to receive paclitaxel 90 mg/m2 or nanopaclitaxel 150 mg/m2 or isapirone 16 mg/m2 once weekly, both in combination with Bev 10 mg/kg every 2 weeks. The results showed that the median PFS was significantly better in the paclitaxel group (11 months vs 7.4 months, HR: 1.59; 95% CI 1.31-1.93; P<0.001< span="">) and not better in the nano-paclitaxel (9.3 months) than in the paclitaxel (HR: 1.20; 95% CI 1.00-1.45; P=0.054). the OS profile was consistent with this. Out-of-plan exploratory analysis showed that paclitaxel PFS was also significantly better than ifapirone in the TNBC subgroup (7.4 months vs 5.6 months, HR: 0.57; 95% CI 1.08-2.29; P=0.020), whereas nanopaclitaxel (6.5 months) was not better than paclitaxel (HR: 0.86; 95% CI 0.60-1.25; P=0.43). In addition, hematologic and non-hematologic toxicity was significantly increased in the nanopaclitaxel group, with an earlier and more frequent need for dose reduction. Therefore, in patients with advanced breast cancer treated with chemotherapy priming, the paclitaxel once-weekly regimen remains the preferred microtubule inhibitor regimen for first-line treatment of metastatic breast cancer, and there is no evidence that newer agents such as isapirone and nanopaclitaxel are superior to paclitaxel (J Clin Oncol 33:2361-2369). IV. Summary In 2015, research related to chemotherapy for breast cancer remained a hot area, with TNBC having a relatively poor prognosis and remaining one of the difficulties in breast cancer treatment; whereas advances in the treatment of Luminal A breast cancer suggest that individualized consideration can be made for patients’ histological staging and biological differences, leading to the selection of the treatment option with the highest risk-benefit ratio. The advances in the treatment of both groups of patients are summarized as follows: postmenopausal patients with invasive Luminal A breast cancer do not benefit from cyclophosphamide-based chemotherapy; in HER2-negative patients with residual disease despite neoadjuvant chemotherapy, adjuvant capecitabine in addition to standard paclitaxel and/or anthracycline regimens may improve survival; in patients with early stage and stage II-III TNBC, standard chemotherapy with paclitaxel and/or anthracycline-based regimens may improve survival. Both paclitaxel-based standard chemotherapy plus carboplatin significantly increased the pCR rate of patients, suggesting a possible improvement in survival prognosis; carboplatin + nano-paclitaxel regimen was superior to gemcitabine + nano-paclitaxel regimen for TNBC; docetaxel + carboplatin + Bev combination neoadjuvant therapy for TNBC resulted in satisfactory pCR rate and survival prognosis; for HER2-negative and advanced TNBC breast cancer patients, paclitaxel is superior to nano-paclitaxel and isapirone; therefore, weekly regimen of paclitaxel remains the preferred microtubule inhibitor regimen for advanced breast cancer.