Evidence-based use of taxanes in the adjuvant setting of breast cancer. A review of randomized phase III trials.
Six major randomized clinical trials evaluating the role of taxanes in the adjuvant setting of breast cancer have demonstrated significant improvements in terms of efficacy in favour of the taxane treatment arm. In all cases, different anthracycline-based regimens were used as the control arm. Nevertheless, many clinicians are still not sufficiently convinced to incorporate the routine use of taxanes in the adjuvant treatment of breast cancer. There are two main objections, first the possible lack of effectiveness of chemotherapy in hormone-receptor positive tumors and second, some of the anthracycline-based control arms used in these trials were not the optimal ones. In this review, we have searched and analyzed all randomized studies that evaluated the role of taxanes in the adjuvant setting of breast cancer patients and have reported results in terms of efficacy or tolerance. The suitability of the control arm, the prospective definition of patient's subgroups and the statistical methodology were taking into account. The objective of this review was to analyze if, at this point in time, there is sufficient evidence to support the routine use of taxanes in the adjuvant setting of breast cancer, and if it is valid for all subgroups including hormone-receptor and Her2/neu positive breast cancer patients. Other objectives of this review were to define the optimal regimen for administration of taxanes, how the tolerability of taxanes may be improved and also, to investigate any potential differences in efficacy or tolerability between docetaxel and paclitaxel.
Estévez
Laura G
LG
Centro Integral Oncológico, Clara Campal, Madrid, Spain. borabora@pol2.jazztel.es
Muñoz
Montserrat
M
Alvarez
Isabel
I
Fernández
Yolanda
Y
García-Mata
Jesús
J
Ruiz-Borrego
Manuel
M
Tusquets
Ignasi
I
Seguí
Miguel Angel
MA
Rodríguez-Lescure
Alvaro
A
Adrover
Encarna
E
Lluch
Ana
A
D018943:Anthracyclines / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D017326:Clinical Trials, Phase III as Topic; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D043823:Taxoids / Q000627:therapeutic use*
D018943:Anthracyclines; D043823:Taxoids