Adjuvant chemotherapy after early breast cancer surgery has been widely recognized and used worldwide to improve recurrence-free survival and overall survival. A large number of clinical studies have established the status of anthracyclines and paclitaxel in adjuvant chemotherapy, and the focus of current research is on how to apply these drugs more rationally and effectively, and how to combine them with targeted drugs in order to find more effective and better tolerated adjuvant chemotherapy regimens. I. Whether the combination or sequential application of paclitaxel and anthracyclines BCIRG005 first reported the results of the combination or sequential application of adriamycin, docetaxel and cyclophosphamide, i.e., TAC (Docetaxel + Doxorubicin + Cyclophosphamide) and AC-T (Doxorubicin + Cyclophosphamide sequential). Docetaxel) regimen in a phase III international multicenter randomized controlled study. Previously completed clinical studies such as BCIRG001 and GEICAM9805 have demonstrated that the TAC regimen further improved relapse-free survival (DFS) and overall survival (OS) compared to FAC (5-FU + Doxorubicin + Cyclophosphamide), reducing the risk of relapse by 28% and the risk of death by 30%, but TAC had a significant 3-4 degree neutropenia compared to FAC, increasing the risk of granulocytopenic fever. The purpose of the BCIRG005 study was to compare the DFS, OS, and tolerability of the AC-T and TAC regimens. From August 2000 to February 2003, 3298 operable patients with positive axillary lymph nodes and Her-2 negative were entered into the clinical study and randomized to TAC x 6 cycles (75/50/500 mg/m2 q3wk) or AC x 4 (60/600 mg/m2 q3wk) sequential T x 4 (100 mg/m2 q3wk) regimens of chemotherapy, and patients enrolled The median age was 50 years, 61% of the patients had 1-3 positive axillary lymph nodes, 31% had ≥4 positive lymph nodes, 82% had positive ER, and those requiring radiotherapy or endocrine therapy were treated after chemotherapy. At a median follow-up of 60 months, DFS was 78.9% and 78.6% ( P=0.98, HR1.002) and OS was 88.1% and 88.9% ( P=0.37, HR0.91) in the TAC and AC-T groups, respectively, and subgroup analysis showed that neither receptor status nor the number of positive axillary lymph nodes affected the outcome of the two groups. Adverse effects were still higher in the TAC regimen with 17.9% granulocytopenic fever and 8.3% AC-T (P<0.0001). Therefore, the investigators concluded that the efficacy of the two regimens is comparable and can be applied individually according to the patient, but it is worth noting that although ac-t increased the dose intensity but still did not further improve dfs and os, and the chemotherapy cycle is longer, which may affect the patient's quality of life more, so it is recommended that the preferred tac regimen chemotherapy can be considered under the premise of prophylactic use of g-csf. < span=""> The results of another large multicenter clinical study, NSABP B-30, were also reported for the first time at this meeting. Its design was a direct comparison of three regimens, TAC×4 cycle, TA (Docetaxel+ Doxorubicin)×4 cycle, and AC×4→T×4 cycle. The main objectives were firstly, whether the combination of TAC×4 cycle could further improve DFS and OS compared with sequential application of AC×4→T×4 cycle; and secondly, whether TA×4 cycle was comparable to TAC×4 cycle and The results showed that AC→T improved DFS by 17% (P=0.006) and TA by 20% (P=0.001) compared with TAC, while TAC and TA were basically equivalent (P=0.58). Overall survival showed a statistically significant difference of 17% (P=0,034) reduction in risk of death with AC→T compared to TA, 14% (P=0,086) reduction in risk of death compared to TAC, which had not reached statistical difference, and no statistically significant difference between TAC and TA. Subgroup analysis including age, menstrual status, tumor size, number of positive axillary lymph nodes and receptor status did not affect these results. In addition, the investigators performed analysis of adverse effects, quality of life and chemotherapy-induced menopause (≥6 months). 22% of the AC→T group, 16% of the TAC and 13% of the TA had granulocytopenic fever of degree 3 to 4 (P<0.0001 ); quality of life recovery time after chemotherapy was 26 weeks in the AC→T group and 16 weeks in the TAC and TA groups; menopause due to chemotherapy was 86% in the AC→T group, TAC 82%, TA 69%, and the analysis showed that DFS and OS were better in patients who had stopped menstruation for more than 6 months in chemotherapy than in those who had not stopped menstruation. Based on the above results the investigators concluded that DFS was better in the AC→T group than TAC in this trial, but it should be considered that in this study the TAC regimen was only 4 cycles, not the commonly used 6 cycle standard regimen, and the difference in OS between the two groups was not significant, therefore. The DFS and OS of the TA group were lower than those of the AC→T group, but basically comparable to those of the TAC group, and if the reproductive function and quality of life are considered, the TA regimen can also be used in clinical practice. Whether paclitaxel can partially or completely replace anthracyclines Anthracyclines are the standard adjuvant chemotherapy for early-stage breast cancer, but their long-term cardiotoxicity is getting more and more attention, and whether paclitaxel can partially or completely replace anthracyclines is one of the hot spots in today's research. The effectiveness and tolerability of the EC→DOC study, which compares standard ECF x 6 cycles (100/500/500mg/m2 q3w) with EC x 4 cycles (90/600mg/m2 q3w) → Docetaxel x 4 cycles (100mg/m2 q3w) in patients with 1-3 positive lymph nodes. 2011 eligible patients entered the study with a median follow-up of 41 months, and the 5-year DFS was 86% and 91% (p=0.005), respectively, extrapolated from the current results; OS was 90% and The final results and subgroup analysis will be further reported. Another phase III randomized controlled study, NSASBC02, reported interim results from December 2000 to March 2006, in which 1060 eligible patients were enrolled and randomized to four regimens of chemotherapy, AC (60/600 mg/m2 q3w) × 4 → P (Paclitaxel 175 mg/m2 q3w) × 4; AC × 4 → T (Docetaxel 75 mg/m2 q3w) × 4; single agent P × 8; single agent T × 8, with a median follow-up of 46.5 months, and preliminary results showed that the AC → T group had the best DFS. Preliminary results showed that the AC→T group had the best DFS, followed by the AC→P group, single agent D group and single agent P group, respectively, and the anthracycline-sequential paclitaxel group was superior to the single paclitaxel group in the Her-2 high expression subgroup, with grade 3-4 adverse effects up to 30% in the AC→D group and down to 14% in the single agent P group. Follow-up of this study is still ongoing and to be reported subsequently. Jones et al. reported the results of the US9735 study at SABCS 2007, which aimed to directly compare the efficacy and safety of the AC (60/600 mg/m2 q3w) x 4 versus TC (75/600 mg/m2 q3w) x 4 regimen, with a follow-up of up to 7 years. The TC group was superior to the AC group, and the differences were all statistically significant. The investigators suggested that TC could replace AC as an adjuvant chemotherapy regimen for patients with a low to moderate risk of recurrence or for whom anthracyclines are inappropriate. The advantages of TC regimens in terms of economic benefits were further established at this congress. Several clinical trials have demonstrated that the addition of Herceptin to chemotherapy can further improve DFS and OS in Her-2 high expressing early stage breast cancer. The TCH (docetaxel + carboplatin + Herceptin) regimen in the BCIRG006 study demonstrated its safety and efficacy and is considered to be one of the standard regimens for Her-2 high expression early stage breast cancer, and the TC regimen in combination with Herceptin in the US9735 study is also an option. For example, the safety of intensive AC→T+H+L (Lapatinib) was observed in about 50% of patients with 3rd-4th degree diarrhea, requiring a reduction in the daily dose of Lapatinib and awaiting the results of the ALTTO trial; bevacizumab in combination with AC→T, TAC or TCH The phase II safety study of AC→T+Sorafenib (Doxorubicin) showed that 47% of patients discontinued treatment due to grade 3-4 adverse reactions, and it is recommended that it should not be used in conjunction with chemotherapy drugs. Therefore, more prospective randomized controlled studies are needed on how to combine chemotherapy with targeted agents to achieve a synergistic and well-tolerated regimen.