Taxanes alone or in combination with anthracyclines as first-line therapy of patients with metastatic breast cancer
Piccart-Gebhart, M.J. × Burzykowski, T. Buyse, M. Sledge, G. Carmichael, J. Lück, H.J. Mackey, J.R. Nabholtz, J.M. Paridaens, Robert Biganzoli, L. Jassem, J. Bontenbal, M. Bonneterre, J. Chan, S. Basaran, G.A. Therasse, P. #
Grune & Stratton
Journal of Clinical Oncology vol:26 issue:12 pages:1980-1986
Purpose: Taxanes (paclitaxel or docetaxel) have been sequenced or combined with anthracyclines (doxorubicin or epirubicin) for first-line treatment of advanced breast cancer. The 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.
Patients and methods: Individual 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 3034 patients; single-agent trials included 919 patients.
Results: 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.
Conclusion: Taxanes were significantly worse than single-agent anthracyclines in terms of PFS, but not in terms of response rates on survival. Taxane-based combinations were significantly better than anthracycline-based combinations in terms of response rates and PFS, but not in terms of survival.