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
ReviewSystematic review of taxane-containing versus non-taxane-containing regimens for adjuvant and neoadjuvant treatment of 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
References (23)
- et al.
Initial paclitaxel improves outcome compared with CMFP combination chemotherapy as front-line therapy in untreated metastatic breast cancer
J Clin Oncol
(1999) - et al.
Prospective randomized trial of docetaxel versus doxorubicin in patients with metastatic breast cancer
J Clin Oncol
(1999) - et al.
Taxanes for metastatic breast cancer
The Cochrane Library. Issue 3
(2003) - et al.
Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints
Stat Med
(1998) - et al.
The effect on tumor response of adding sequential preoperative docetaxel to preoperative doxorubicin and cyclophosphamide: preliminary results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27
J Clin Oncol
(2003) - et al.
Prospective evaluation of paclitaxel versus combination chemotherapy with fluorouracil, doxorubicin, and cyclophosphamide as neoadjuvant therapy in patients with operable breast cancer
J Clin Oncol
(1999) - et al.
Prospective randomized study of neoadjuvant chemotherapy with paclitaxel/epirubicin versus fluorouracil/epirubicin/cyclophos-phamide in operable stage II-IIIA breast cancer
Ann Oncol
(1998) - et al.
Neoadjuvant chemotherapy in breast cancer: significantly enhanced response with docetaxel
J Clin Oncol
(2002) - et al.
Preliminary results of a multicentre phase III trial of taxotere and doxorubicin verus 5-fluorouracil, doxorubicin and cyclophosphamide in patients with unresectable locally advanced breast cancer
Proc Am Soc Clin Oncol
(2001) - et al.
Three-year results of a prospective randomized trial of adjuvant chemotherapy for patients with stage I–III operable, invasive breast cancer comparing four courses of doxorubicin/cyclophosphamide to four courses of docetaxel/cyclophosphamide
Proc Am Soc Clin Oncol
(2003)
Paclitaxel following doxorubicin/cyclophosphamide as adjuvant chemotherapy for node-positive breast cancer
Proc Am Soc Clin Oncol
Cited by (99)
Adjuvant dose-dense doxorubicin-cyclophosphamide versus docetaxel-doxorubicin-cyclophosphamide for high-risk breast cancer: First results of the randomised MATADOR trial (BOOG 2004-04)
2018, European Journal of CancerCitation Excerpt :Currently ongoing gene expression analyses might provide hints on the biology that could be driving this. The regimens used in our cohort displayed distinct toxicity profiles, which are in line with previous studies on dose-dense chemotherapy [4,13] and reports on taxane-based treatments [23,24]. AML and MDS were observed in 2 (0.6%) of 327 ddAC-treated patients and 2 (0.6%) of 319 TAC-treated patients.
Paclitaxel: What has been done and the challenges remain ahead
2017, International Journal of PharmaceuticsOver-using chemotherapy in the adjuvant setting
2017, BreastCitation Excerpt :In the past 35 years, several chemotherapy regimens have been used in the adjuvant setting. The three chemotherapy regimens that have proved to substantially improve breast cancer outcome are: 1) cyclophosphamide, methotrexate, and 5- fluorouracil (CMF) regimen, 2) the anthracycline-based regimens, and 3) the taxane-based regimens [1–3]. According to the results of the meta-analysis conducted by the Early Breast Cancer Trialists' Collaborative Group (EBCTCG), adjuvant chemotherapy decreased the annual relative risk of relapse and mortality by 23% and 17%, respectively [1].
Breast Cancer
2016, International Encyclopedia of Public Health