Taxane-Based Combinations As Adjuvant Chemotherapy of Early Breast Cancer: A Meta-Analysis of Randomized Trials

Laurentiis, Michelino De; Cancello, Giuseppe; D’Agostino, Diana; Giuliano, Mario; Giordano, Antonio; Montagna, Emilia; Lauria, Rossella; Forestieri, Valeria; Espósito, Angela; Silvestro, Lucrezia; Pennacchio, Roberta Maria; Criscitiello, Carmen; Montanino, Agnese; Limite, Gennaro; Bianco, Angelo Raffaele; Placido, Sabino De

doi:10.1200/jco.2007.11.3787

Cited by 376 publications

(211 citation statements)

References 25 publications

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“…Despite the above possible limitations, the results are favoring docetaxel administration. Our results are in agreement with cumulative evidence from other studies [6], including a recent meta-analysis, which also support the incorporation of docetaxel into anthracycline-based adjuvant chemotherapy [9].…”

Section: Yes Nosupporting

confidence: 92%

“…Taxane administration resulted in an absolute five-year risk reduction of 5% for DFS and 3% for OS. The DFS benefit was independent of estrogen receptor expression, degree of nodal involvement, type of taxane, age/menopausal status of patient, and administration schedule [9].…”

Section: Introductionmentioning

confidence: 89%

“…In the event of febrile neutropenia or grade 3 or 4 neutropenia, G-CSF [Filgrastim (Granocyte, Sanofi-Aventis) 5 lg Kg -1 day -1 on days [4][5][6][7][8][9][10][11] was administered in all subsequent chemotherapy cycles. If a second episode of grade 3 or 4 neutropenia or febrile neutropenia occurred despite the administration of G-CSF or in case of grade 3 or 4 thrombocytopenia, the doses of all drugs were reduced by 20% in subsequent cycles.…”

Section: Methodsmentioning

confidence: 99%

“…Based on their significant activity in the metastatic setting [2], the taxanes have also been extensively tested in the adjuvant setting in many randomized trials [3][4][5][6][7][8]; significant improvement in efficacy outcomes in terms of disease-free survival (DFS) [4,5] and overall survival (OS) [3,6,7] has been reported. Moreover, recently, a meta-analysis of 13 randomized studies including 22,903 patients demonstrated that the addition of a taxane to an anthracycline-based regimen improves DFS and OS of high-risk early breast cancer patients [9]. Taxane administration resulted in an absolute five-year risk reduction of 5% for DFS and 3% for OS.…”

Section: Introductionmentioning

confidence: 99%

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FEC versus sequential docetaxel followed by epirubicin/cyclophosphamide as adjuvant chemotherapy in women with axillary node-positive early breast cancer: a randomized study of the Hellenic Oncology Research Group (HORG)

Polyzos

Malamos²,

Boukovinas

et al. 2009

Breast Cancer Res Treat

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International audienceA randomized multicenter phase III study was conducted to compare the sequential docetaxel followed by epirubicin/cyclophosphamide combination with that of FEC regimen as adjuvant chemotherapy in women with axillary node-positive early breast cancer. Seven hundred and fifty-six women with axillary lymph node-positive breast cancer were randomized to receive either 4 cycles of docetaxel (100 mg/m) followed by 4 cycles of epirubicin (75 mg/m) plus cyclophosphamide (700 mg/m) (experimental arm) or 6 cycles of FEC (epirubicin 75 mg/m, cyclophosphamide 700 mg/m, and 5-fluorouracil 700 mg/m; control arm). All regimes were administered every 3 weeks. The primary end point was five-year disease-free survival (DFS). After a median follow-up period of 5 years, 233 (30.8%) relapses had occurred (108 and 125 in the experimental and control arms, respectively; = 0.181). The five-year DFS was 72.6% (95% CI 63.8–81.3%) and 67.2% (95% CI 58.0–76.4%) for women randomized in the experimental and control arms, respectively ( = 0.041; log rank test). There was no difference in the overall survival between the two arms (83.8 and 81.4% in the experimental and control arms, respectively; = 0.533). The experimental arm was associated with increased neutropenia requiring administration of granulocyte colony-stimulating factor in 90.5% of the patients as compared with 74.1% in the control arm ( = 0.0001). The sequential docetaxel followed by epirubicin/cyclophosphamide adjuvant chemotherapy regimen resulted in improved five-year DFS in women with axillary node-positive early breast cancer at the expense of increased but manageable myelotoxicity

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Section: Yes Nosupporting

confidence: 92%

Section: Introductionmentioning

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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FEC versus sequential docetaxel followed by epirubicin/cyclophosphamide as adjuvant chemotherapy in women with axillary node-positive early breast cancer: a randomized study of the Hellenic Oncology Research Group (HORG)

Polyzos

Malamos²,

Boukovinas

et al. 2009

Breast Cancer Res Treat

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“…The benefit of the addition of taxanes to therapy for women with high-risk nonmetastatic breast cancer has also been shown in prospective studies and meta-analyses. 16 Cristofanilli et al 12 retrospectively compared 178 women with IBC who were treated with an anthracycline-only regimen compared with 62 women with IBC who received both an anthracycline and taxanes and reported that the group receiving taxanes had a higher pathological complete response rate and higher progression-free and overall survival compared with the group that did not. With such advances made in the treatment of IBC and non-IBC LABC, one could potentially begin to question whether survival differences still exist between the 2 groups.…”

Section: Discussionmentioning

confidence: 99%

Differences in survival among women with stage III inflammatory and noninflammatory locally advanced breast cancer appear early

Dawood

Ueno

Valero

et al. 2010

Cancer

124

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BACKGROUND: Significant improvements in the survival of women with breast cancer have been observed and are attributed to a multidisciplinary approach and the introduction of polychemotherapy and endocrine regimens. The objective of this population-based study was to determine whether women with inflammatory breast cancer (IBC) who received treatment in a modern era had a poorer survival compared those with non-IBC locally advanced breast cancer (LABC). METHODS: The Surveillance, Epidemiology, and End Results program registry was searched to identify women with stage IIIB/C breast cancer diagnosed between 2004 and 2007 who had undergone surgery and radiotherapy. Patients were categorized as either having IBC or non-IBC LABC according the sixth edition of the American Joint Committee on Cancer (AJCC) criteria. Breast cancer-specific survival (BCS) was estimated using the Kaplan-Meier product limit method and compared across groups using the log-rank statistic. Cox models were then fitted to compare the association between breast cancer type and BCS after adjusting for patient and tumor characteristics. RESULTS: A total of 828 (19.2%) women and 3476 (80.8%) women had stage IIIB/C IBC and non-IBC LABC, respectively. The median follow-up was 19 months. The 2-year BCS rate was 90% (95% confidence interval [95% CI], 88%-91%) for the entire cohort and 84% (95%CI, 80%-87%) and 91% (95%CI, 90%-91%) among women with IBC and non-IBC LABC, respectively. In the multivariable model, patients with IBC were found to have a 43% increased risk of death from breast cancer compared with patients with non-IBC LABC (hazard ratio, 1.43; 95%CI, 1.10-1.86 [P ¼ .008]). CONCLUSIONS: In the era of multidisciplinary management and anthracycline-based and taxane-based polychemotherapy regimens, women with IBC continue to have worse survival outcomes compared with those with non-IBC LABC.

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Effectiveness of an Adjuvant Chemotherapy Regimen for Early-Stage Breast Cancer

Fujii

Xiao

et al. 2015

JAMA Oncol

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IMPORTANCE Different adjuvant chemotherapy regimens are available for early-stage breast cancer. Because conventional meta-analysis does not allow comparing all regimens, we performed a network meta-analysis to identify the most effective adjuvant chemotherapy regimen. OBJECTIVE To find the most effective adjuvant therapy regimen for early-stage breast cancer. DATA SOURCES We searched MEDLINE, Embase, and the Cochrane Library for articles published before June 2015; the American Society of Clinical Oncology annual meeting abstracts from January 1983 through December 2014; and the American Association for Cancer Research annual meeting abstracts from January 1916 through December 2014. Additionally, we manually searched bibliographies for related references. STUDY SELECTION We included randomized clinical trials of adjuvant treatments for early-stage breast cancer that compared 2 or more of the following: no adjuvant chemotherapy; sequential anthracycline-cyclophosphamide and taxane (AC-T); concurrent anthracycline-cyclophosphamide and taxane (ACT); anthracycline-cyclophosphamide without taxane (AC); docetaxel and cyclophosphamide (TC); cyclophosphamide, methotrexate, and fluorouracil (CMF); and platinum-containing regimens. DATA EXTRACTION AND SYNTHESIS We followed the PRISMA guidelines. Two investigators independently selected the articles and extracted information. Disagreements were resolved by discussion with another author. Quality was assessed by Cochrane risk-of-bias method. Data were pooled using random-effects models. MAIN OUTCOMES AND MEASURES We used network meta-analysis to test the most effective adjuvant therapy regimen in terms of overall survival (OS) by comparing regimens listed in the National Comprehensive Cancer Network guidelines and platinum-containing regimens. RESULTS We identified 24 trials. The TC and platinum-containing regimens had OS benefit similar to that of sequential AC-T (TC hazard ratio [HR], 0.93; 95%CI, 0.62–1.40; and platinum HR, 0.93; 95%CI, 0.66–1.31). Patients treated with CMF or AC had significantly worse OS than those treated with sequential AC-T (CMF HR, 1.56; 95%CI, 1.32–1.85; and AC HR, 1.22; 95%CI, 1.10–1.37). Platinum-containing regimens tended to be more toxic than sequential AC-T. The toxicity of TC was similar to or less than that of sequential AC-T. Meta-regression analysis showed that hormone receptor status did not impact the HRs for OS for any regimen. CONCLUSIONS AND RELEVANCE Sequential AC-T is likely to be the most effective adjuvant therapy regimen for early-stage breast cancer regardless of hormone receptor status.

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Taxane-Based Combinations As Adjuvant Chemotherapy of Early Breast Cancer: A Meta-Analysis of Randomized Trials

Abstract: The addition of a taxane to an anthracycline-based regimen improves the DFS and OS of high-risk EBC patients. The DFS benefit was independent of ER expression, degree of nodal involvement, type of taxane, age/menopausal status of patient, and administration schedule.

Cited by 376 publications

References 25 publications

FEC versus sequential docetaxel followed by epirubicin/cyclophosphamide as adjuvant chemotherapy in women with axillary node-positive early breast cancer: a randomized study of the Hellenic Oncology Research Group (HORG)

FEC versus sequential docetaxel followed by epirubicin/cyclophosphamide as adjuvant chemotherapy in women with axillary node-positive early breast cancer: a randomized study of the Hellenic Oncology Research Group (HORG)

Differences in survival among women with stage III inflammatory and noninflammatory locally advanced breast cancer appear early

Effectiveness of an Adjuvant Chemotherapy Regimen for Early-Stage Breast Cancer

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