title: Docetaxel compared with sequential methotrexate and 5-fluorouracil in patients with advanced breast cancer after anthracycline failure: a randomised phase III study with crossover on progression by the Scandinavian Breast Group.
abstract: The aim of this study was to compare the efficacy and tolerability of docetaxel to methotrexate and 5-fluorouracil in advanced breast cancer after anthracycline failure. A randomised multicentre trial was conducted in 283 patients with advanced breast cancer who had failed previous anthracycline treatment. Docetaxel at a dose of 100 mg/m2 every 3 weeks (n = 143) was compared with sequential methotrexate and 5-fluorouracil (MF; n = 139) given at day 1 and 8 every 3 weeks at dosages of 200 mg/ m2 and 600 mg/m2, respectively. After progression, crossover to the alternative treatment group was recommended. There was a significantly higher overall response rate in the docetaxel 42% (CR 8% + PR 34%) than in the MF arm 21% (CR 3% + PR 18%) (P < 0.001). The median time to progression (TTP) was 6.3 months in the docetaxel arm and 3.0 months in the MF arm (P < 0.001). Docetaxel also had a significantly higher response rate of 27% following crossover compared with MF (12%). Significantly more side-effects (leucopenia, infections, neuropathy, oedema, asthenia, skin, nail changes, alopecia) were seen in the docetaxel than in the MF group. However, grade 3 and 4 side-effects were infrequent with both drugs, with the exception of fatigue, alopecia and infections. Median overall survival (OS) including crossover phase was 10.4 months in the docetaxel and 11.1 months in the MF arm (P = 0.79). Based on the response rate and the primary endpoint of TTP, docetaxel is superior to sequential methotrexate and 5-fluorouracil in advanced breast cancer after anthracycline failure.
authors.affiliation: Department of Oncology, Helsinki University Central Hospital, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Sjöström
authors.forename: C
authors.initials: C
authors.lastname: Blomqvist
authors.forename: H
authors.initials: H
authors.lastname: Mouridsen
authors.forename: A
authors.initials: A
authors.lastname: Pluzanska
authors.forename: S
authors.initials: S
authors.lastname: Ottosson-Lönn
authors.forename: N O
authors.initials: NO
authors.lastname: Bengtsson
authors.forename: B
authors.initials: B
authors.lastname: Ostenstad
authors.forename: I
authors.initials: I
authors.lastname: Mjaaland
authors.forename: M
authors.initials: M
authors.lastname: Palm-Sjövall
authors.forename: E
authors.initials: E
authors.lastname: Wist
authors.forename: V
authors.initials: V
authors.lastname: Valvere
authors.forename: H
authors.initials: H
authors.lastname: Anderson
authors.forename: J
authors.initials: J
authors.lastname: Bergh
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D018592:Cross-Over Studies; D018450:Disease Progression; D000077143:Docetaxel; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage / Q000031:analogs & derivatives; D010349:Patient Compliance; D043823:Taxoids; D017211:Treatment Failure
chemical_list: D000903:Antibiotics, Antineoplastic; D043823:Taxoids; D000077143:Docetaxel; D017239:Paclitaxel; D005472:Fluorouracil; D008727:Methotrexate