Taxanes Alone or in Combination With Anthracyclines As First-Line Therapy of Patients With Metastatic Breast Cancer

• Published in: Journal of clinical oncology Vol. 26; no. 12; pp. 1980 - 1986
• Main Authors: PICCART-GEBHART, Martine J, BURZYKOWSKI, Tomasz, JASSEM, Jacek, BONTENBAL, Marijke, BONNETERRE, Jacques, CHAN, Stephen, BASARAN, Gul Atalay, THERASSE, Patrick, BUYSE, Marc, SLEDGE, George, CARMICHAEL, James, LÜCK, Hans-Joachim, MACKEY, John R, NABHOLTZ, Jean-Marc, PARIDAENS, Robert, BIGANZOLI, Laura
• Format: Journal Article
• Language: English
• Published: Baltimore, MD American Society of Clinical Oncology 20-04-2008; Lippincott Williams & Wilkins
• Subjects: Anthracyclines - administration & dosage; Anthracyclines - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Breast Neoplasms - drug therapy; Breast Neoplasms - pathology; Disease-Free Survival; Female; Gynecology. Andrology. Obstetrics; Humans; Mammary gland diseases; Medical sciences; Neoplasm Metastasis; Proportional Hazards Models; Randomized Controlled Trials as Topic; Survival Rate; Taxoids - administration & dosage; Taxoids - therapeutic use; Tumors; Human; Drug combination; Breast disease; Breast cancer; Malignant tumor; Metastasis; First line treatment; Mammary gland diseases; Cancerology; Taxane derivatives; Advanced stage; Anthracyclins; Cancer
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2007.10.8399

Taxanes (paclitaxel or docetaxel) have been sequenced or combined with anthracyclines (doxorubicin or epirubicin) for the first-line treatment of advanced breast cancer. This meta-analysis uses data from all relevant trials to detect any advantages of taxanes in terms of tumor response, progression-free survival (PFS), and survival.
Individual patient data were collected on eight randomized combination trials comparing anthracyclines + taxanes (+ cyclophosphamide in one trial) with anthracyclines + cyclophosphamide (+ fluorouracil in four trials), and on three single-agent trials comparing taxanes with anthracyclines. Combination trials included 3,034 patients; single-agent trials included 919 patients.
Median follow-up of living patients was 43 months, median survival was 19.3 months, and median PFS was 7.1 months. In single-agent trials, response rates were similar in the taxanes (38%) and in the anthracyclines (33%) arms (P = .08). The hazard ratios for taxanes compared with anthracyclines were 1.19 (95% CI, 1.04 to 1.36; P = .011) for PFS and 1.01 (95% CI, 0.88 to 1.16; P = .90) for survival. In combination trials, response rates were 57% (10% complete) in taxane-based combinations and 46% (6% complete) in control arms (P < .001). The hazard ratios for taxane-based combinations compared with control arms were 0.92 (95% CI, 0.85 to 0.99; P = .031) for PFS and 0.95 (95% CI, 0.88 to 1.03; P = .24) for survival.
Taxanes were significantly worse than single-agent anthracyclines in terms of PFS, but not in terms of response rates or survival. Taxane-based combinations were significantly better than anthracycline-based combinations in terms of response rates and PFS, but not in terms of survival.