title: Taxanes alone or in combination with anthracyclines as first-line therapy of patients with metastatic breast cancer.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Institut Jules Bordet, 121 boulevard de Waterloo, 1000 Brussels, Belgium. martine.piccart@bordet.be
authors.forename: Martine J
authors.initials: MJ
authors.lastname: Piccart-Gebhart
authors.forename: Tomasz
authors.initials: T
authors.lastname: Burzykowski
authors.forename: Marc
authors.initials: M
authors.lastname: Buyse
authors.forename: George
authors.initials: G
authors.lastname: Sledge
authors.forename: James
authors.initials: J
authors.lastname: Carmichael
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Lück
authors.forename: John R
authors.initials: JR
authors.lastname: Mackey
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Nabholtz
authors.forename: Robert
authors.initials: R
authors.lastname: Paridaens
authors.forename: Laura
authors.initials: L
authors.lastname: Biganzoli
authors.forename: Jacek
authors.initials: J
authors.lastname: Jassem
authors.forename: Marijke
authors.initials: M
authors.lastname: Bontenbal
authors.forename: Jacques
authors.initials: J
authors.lastname: Bonneterre
authors.forename: Stephen
authors.initials: S
authors.lastname: Chan
authors.forename: Gul Atalay
authors.initials: GA
authors.lastname: Basaran
authors.forename: Patrick
authors.initials: P
authors.lastname: Therasse
mesh_terms: D018943:Anthracyclines / Q000008:administration & dosage / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D009362:Neoplasm Metastasis; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D018943:Anthracyclines; D043823:Taxoids