Balancing activity and tolerability of neoadjuvant paclitaxel- and docetaxel-based chemotherapy for HER2-positive early stage breast cancer: Sensitivity analysis of randomized trials

Luisa Carbognin, Isabella Sperduti, Rolando Nortilli, Matteo Brunelli, Cecilia Vicentini, Francesca Pellini, Giovanni Paolo Pollini, Diana Giannarelli, Giampaolo Tortora, Emilio Bria

Research output: Contribution to journalArticle

Abstract

Paclitaxel and docetaxel represent the most adopted taxanes in the neoadjuvant treatment of HER2-positive breast cancer. Questions still remain with regard to their difference in terms of activity and tolerability.Events for pathological complete response (pCR), severe and febrile neutropenia (FN), and severe neurotoxicity were pooled by adopting a fixed- and random-effect model. A sensitivity analysis to test for the interaction between paclitaxel and docetaxel was accomplished. Absolute differences with 95% confidence intervals (CIs) and the number of patients needed to treat/harm (NNT/NNH) were calculated to derive the Likelihood of being Helped or Harmed (LHH).Data from 15 trials (3601 patients) were included. Paclitaxel significantly increases pCR rate by 6.8% in comparison with docetaxel (43.4%, 95% CI 41.1-45.7% versus 36.6%, 95% CI 34.3-39.0%, p=. 0.0001), regardless of the chemotherapy backbone, with an absolute difference of 9% and 9.2% for anthracycline-based or free-regimens. Paclitaxel significantly improves pCR versus docetaxel with a single HER2-inhibition by 6.7% (. p=. 0.0012), with no difference if combined with a dual HER2-inhibition. Severe neutropenia and FN are significantly lower with paclitaxel, with an absolute difference of 32.4% (. p

Original languageEnglish
Pages (from-to)262-270
Number of pages9
JournalCancer Treatment Reviews
Volume41
Issue number3
DOIs
Publication statusPublished - Mar 1 2015

Keywords

  • Breast cancer
  • Docetaxel
  • HER2-positive
  • Neoadjuvant
  • Paclitaxel
  • Sensitivity analysis

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

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