Docetaxel and Paclitaxel in the Treatment of Breast Cancer: A Review of Clinical Experience

Abstract

In the 10 years since their initial licensing in Europe, the taxanes, paclitaxel and docetaxel, have emerged as fundamental drugs in the treatment of breast cancer. Clinically meaningful benefits were first shown in the metastatic setting, and large-scale exploration of their roles in the adjuvant therapy of early-stage disease is ongoing. Benefits have been seen in the neoadjuvant setting as well, mainly with docetaxel. This paper reviews the current roles of the taxanes in the treatment of metastatic and early-stage breast cancer. Also addressed are outstanding issues involving optimal dosing and sequencing, as well as a discussion of the relative merits of each agent in this setting. Clinicians should choose a taxane-based regimen for their patients with breast cancer based on consideration of the pharmacokinetics, clinical activity, and dosing schedule that best meets the patients' needs. At the current time, the pharmacokinetic profile, consistent positive clinical results, and convenience of an intermittent, short-infusion schedule have made docetaxel the preferred taxane for many clinicians treating patients with breast cancer. The Oncologist 2004;9(suppl 2): [24][25][26][27][28][29][30][31][32] The Oncologist 2004;9(suppl 2):24-32 www.TheOncologist.com Correspondence: John Crown, M.D., Medical Oncology Research Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland. Telephone: 353-1-2094839; Fax: 353-1-2837719; e-mail: john.crown@icorg.ie Received March 11, 2004; accepted for publication March 22, 2004 accepted for publication March 22, . ©1083-7159/2004 INTRODUCTIONThe taxanes have emerged as critically important drugs in the treatment of patients with breast cancer. The relatively accelerated clinical development of these agents can be attributed to the rapid collection of an unprecedented amount of data from numerous large, high-quality prospective random assignment trials, trials that involved literally tens of thousands of patients.

Usefulness of chemotherapy beyond the second line for metastatic breast cancer: a therapeutic challenge

“…Recurrence-free survival was longer, 32 months, than the 18-19 months reported in retrospective series and the 20-26 months observed in randomized [17,19]. Our recruit ment bias might have had an effect here; the inclusion of wo men who had received at least three chemotherapy lines may have selected patients with less progressive disease, or who were at least more sensitive to treatment.…”

Taxanes for the adjuvant treatment of early breast cancer: systematic review and economic evaluation

“…24 Dose and scheduling may affect tolerability and effectiveness. Paclitaxel is used in a sequential strategy, whereas docetaxel can be used sequentially or in combination with anthracyclines.…”

“…25 In metastatic breast cancer, weekly paclitaxel was more effective than 3-weekly paclitaxel, whereas docetaxel had similar effectiveness weekly or 3-weekly. 24 In metastatic breast cancer, docetaxel was more effective than paclitaxel. 24 Results from a clinical trial (E1199) of Stage 2 and 3 breast cancer comparing paclitaxel and docetaxel found similar effectiveness for both drugs.…”

“…24 In metastatic breast cancer, docetaxel was more effective than paclitaxel. 24 Results from a clinical trial (E1199) of Stage 2 and 3 breast cancer comparing paclitaxel and docetaxel found similar effectiveness for both drugs. Docetaxel and paclitaxel also showed similar effectiveness for weekly or 3-weekly administration.…”

Selective Killing of Adriamycin-Resistant (G2 Checkpoint-Deficient and MRP1-Expressing) Cancer Cells by Docetaxel

“…Docetaxel (Taxotere), a microtubule-stabilizing taxane, is widely used in the therapy of breast, ovarian, prostate, lung, head and neck, gastric, bladder and other cancers (6)(7)(8)(9)). Yet, microtubules are universal cellular structures that are necessary for all normal cells.…”