Taxane-based combinations as adjuvant chemotherapy of early breast cancer: a meta-analysis of randomized trials.
OBJECTIVE
We conducted a meta-analysis of randomized trials that evaluated the efficacy of incorporating taxanes into anthracycline-based regimens for early breast cancer (EBC). We aimed to determine whether this approach improves disease-free survival (DFS) and overall survival (OS) and whether benefits are maintained across relevant patient subgroups.


METHODS
Studies were retrieved by searching the PubMed database and the proceedings of major conferences. We extracted hazard ratios (HR) and 95% CIs for DFS and OS from each trial and obtained pooled estimates using an inverse-variance model.


RESULTS
Thirteen studies were included in the meta-analysis (N = 22,903 patients). The pooled HR estimate was 0.83 (95% CI, 0.79 to 0.87; P < .00001) for DFS and 0.85 (95% CI, 0.79 to 0.91; P < .00001) for OS. Risk reduction was not influenced by the type of taxane, by estrogen receptor (ER) expression, by the number of axillary metastases (N1 to 3 v N4+), or by the patient's age/menopausal status. Sensitivity analysis showed that taxanes given in combination with anthracyclines, unlike sequential administration, did not significantly improve OS. However, the test for interaction showed that HR did not differ between the two schedules (P = .54). Taxane administration resulted in an absolute 5-year risk reduction of 5% for DFS and 3% for OS.


CONCLUSIONS
The addition of a taxane to an anthracycline-based regimen improves the DFS and OS of high-risk EBC patients. The DFS benefit was independent of ER expression, degree of nodal involvement, type of taxane, age/menopausal status of patient, and administration schedule.
De Laurentiis
Michele
M
Dipartimento di Endocrinologia ed Oncologia Molecolare e Clinica, Università di Napoli Federico II, Napoli, Italy. delauren@unina.it
Cancello
Giuseppe
G
D'Agostino
Diego
D
Giuliano
Mario
M
Giordano
Antonio
A
Montagna
Emilia
E
Lauria
Rossella
R
Forestieri
Valeria
V
Esposito
Angela
A
Silvestro
Lucrezia
L
Pennacchio
Roberta
R
Criscitiello
Carmen
C
Montanino
Agnese
A
Limite
Gennaro
G
Bianco
Angelo Raffaele
AR
De Placido
Sabino
S
D018943:Anthracyclines / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D000077143:Docetaxel; D005260:Female; D006801:Humans; D017239:Paclitaxel / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic; D043823:Taxoids / Q000008:administration & dosage
D018943:Anthracyclines; D043823:Taxoids; D000077143:Docetaxel; D017239:Paclitaxel