Elsevier

The Lancet Oncology

Volume 5, Issue 6, June 2004, Pages 372-380
The Lancet Oncology

Review
Systematic review of taxane-containing versus non-taxane-containing regimens for adjuvant and neoadjuvant treatment of early breast cancer

https://doi.org/10.1016/S1470-2045(04)01494-9Get rights and content

Summary

The use of taxanes in early breast cancer is increasing. However, there are few mature studies of taxanes in this setting, and their role is uncertain. Our systematic review of randomised trials of adjuvant or neoadjuvant systemic therapy identified ten reported trials comparing a taxane-containing group with a non-taxane-containing control group in women with early breast cancer. Four of five neoadjuvant trials showed higher rates of complete response with taxanes, although differences were not significant. All five adjuvant trials showed improvements in disease-free survival with taxanes, and these improvements were significant in three trials and independent of oestrogen-receptor status. Two trials showed a significant improvement in overall survival. These results support the use of adjuvant taxanes in women with early breast cancer and involved lymph nodes. Longer follow-up of these trials and results from continuing trials are needed to clarify the best use of taxanes in early breast cancer.

Section snippets

Background

The taxanes (paclitaxel and docetaxel) are among the most active agents in metastatic breast cancer (figure 1).1, 2, 3 Their incorporation into regimens for early breast cancer is increasing in both the neoadjuvant and adjuvant settings in clinical practice. However, mature studies of taxanes for early breast cancer are few, and there is uncertainty about the role of these agents outside clinical trials. This systematic review identifies, organises, and summarises the available evidence that

Neoadjuvant trials

Five eligible reported trials were identified that compared neoadjuvant treatment that contained taxanes with neoadjuvant treatment without taxanes in 2948 women, with pathological complete-response rates reported for 2666 women (table 2).5, 6, 7, 8, 9, 14 The combinations and schedules investigated were very heterogeneous (table1). Two trials6, 7, 14 used paclitaxel and three5, 8, 9 used docetaxel, and although all trials used a 21-day schedule for the taxane-containing group, paclitaxel was

Adjuvant trials

We identified five trials of adjuvant chemotherapy that compared a taxane-containing group with a non-taxane containing group (table 3), including 9211 women, 2512 relapses, and 1591 deaths (table 4). As with the neoadjuvant trials, the treatment approaches investigated were heterogeneous (table 1). Three trials used paclitaxel11, 13, 14 and two used docetaxel.10, 12 Paclitaxel was given over 3 h in two trials,11, 13 and over 24 h in one trial.14 Although all trials used a 21-day schedule in

Other questions and recommendations for further research

Many large, well-designed adjuvant clinical trials that test the addition or substitution of a taxane into previous standard regimens are under way. These will clarify whether taxanes can be substituted for anthracyclines or other drugs; whether the benefits attributed to taxanes in some trials are due to the taxanes or the addition of more cycles; whether one taxane is better than another; and, whether weekly schedules are better than 3-weekly schedules. Larger trials of neoadjuvant

Conclusions

Data are available from ten of 25 trials that assess the addition or substitution of taxanes into the treatment of early breast cancer, that include more than 12 000 women. Neoadjuvant combination regimens including a taxane are active and are a reasonable option if neoadjuvant therapy is to be used. The results of this systematic review support the use of taxanes as adjuvant chemotherapy for women with early breast cancer and involved lymph nodes. The strongest support is for the addition of

Search strategy and selection criteria

The specialised register maintained by the Secretariat of the Cochrane Collaboration Breast Cancer Review Group was searched. The strategy applied by the Group to create the register, and the procedure used to code references, is described in the Group's module on the Cochrane Library. Two updated trial reports of studies previously published in abstract form were identified by screening abstracts from the American Society of Clinical Oncology Meeting, 2003, and a further updated trial

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