Taxane-based combinations as adjuvant chemotherapy of early breast cancer

A meta-analysis of randomized trials

Michele De Laurentiis, Giuseppe Cancello, Diego D'Agostino, Mario Giuliano, Antonio Giordano, Emilia Montagna, Rossella Lauria, Valeria Forestieri, Angela Esposito, Lucrezia Silvestro, Roberta Pennacchio, Carmen Criscitiello, Agnese Montanino, Gennaro Limite, Angelo Raffaele Bianco, Sabino De Placido

Research output: Contribution to journalArticle

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Abstract

Purpose: 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. Conclusion: 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.

Original languageEnglish
Pages (from-to)44-53
Number of pages10
JournalJournal of Clinical Oncology
Volume26
Issue number1
DOIs
Publication statusPublished - Jan 1 2008

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Adjuvant Chemotherapy
Disease-Free Survival
Meta-Analysis
Breast Neoplasms
Survival
Anthracyclines
Taxoids
Risk Reduction Behavior
Estrogen Receptors
Appointments and Schedules
PubMed
taxane
Databases
Neoplasm Metastasis

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Taxane-based combinations as adjuvant chemotherapy of early breast cancer : A meta-analysis of randomized trials. / De Laurentiis, Michele; Cancello, Giuseppe; D'Agostino, Diego; Giuliano, Mario; Giordano, Antonio; Montagna, Emilia; Lauria, Rossella; Forestieri, Valeria; Esposito, Angela; Silvestro, Lucrezia; Pennacchio, Roberta; Criscitiello, Carmen; Montanino, Agnese; Limite, Gennaro; Bianco, Angelo Raffaele; De Placido, Sabino.

In: Journal of Clinical Oncology, Vol. 26, No. 1, 01.01.2008, p. 44-53.

Research output: Contribution to journalArticle

De Laurentiis, Michele ; Cancello, Giuseppe ; D'Agostino, Diego ; Giuliano, Mario ; Giordano, Antonio ; Montagna, Emilia ; Lauria, Rossella ; Forestieri, Valeria ; Esposito, Angela ; Silvestro, Lucrezia ; Pennacchio, Roberta ; Criscitiello, Carmen ; Montanino, Agnese ; Limite, Gennaro ; Bianco, Angelo Raffaele ; De Placido, Sabino. / Taxane-based combinations as adjuvant chemotherapy of early breast cancer : A meta-analysis of randomized trials. In: Journal of Clinical Oncology. 2008 ; Vol. 26, No. 1. pp. 44-53.
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abstract = "Purpose: 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. Conclusion: 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.",
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T1 - Taxane-based combinations as adjuvant chemotherapy of early breast cancer

T2 - A meta-analysis of randomized trials

AU - De Laurentiis, Michele

AU - Cancello, Giuseppe

AU - D'Agostino, Diego

AU - Giuliano, Mario

AU - Giordano, Antonio

AU - Montagna, Emilia

AU - Lauria, Rossella

AU - Forestieri, Valeria

AU - Esposito, Angela

AU - Silvestro, Lucrezia

AU - Pennacchio, Roberta

AU - Criscitiello, Carmen

AU - Montanino, Agnese

AU - Limite, Gennaro

AU - Bianco, Angelo Raffaele

AU - De Placido, Sabino

PY - 2008/1/1

Y1 - 2008/1/1

N2 - Purpose: 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. Conclusion: 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.

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