Info
EBCTCG
Anthracycline plus taxane regimens most efficacious at reducing breast cancer recurrence and death: Individual patient-level meta-analysis
- Design:
- Individual patient-level meta-analysis of randomised trials
- Adjuvant or neoadjuvant trials were eligible if they began before Jan 1, 2012
- Primary outcomes were breast cancer recurrence and cause-specific mortality
- 28 trials of taxane regimens with or without anthracycline were identified, of which 23 were deemed eligible, and 15 provided data on 18 103 women
- 35 trials (n=52 976) provided individual patient data for analysis of anthracycline regimens with versus without taxane
- Number of patients:
- 18,103 women in 15 trials of taxane regimens
- 52,976 women in 35 trials of anthracycline regimens
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Patients characteristics: Not reported
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Agent:
- Anthracycline and taxane chemotherapy
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Treatment line: Adjuvant or neoadjuvant
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Trial Name or NCT Number: Not reported
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Comparison between two groups in the form of a markdown table:
| Comparison | Outcome | Results |
|---|---|---|
| Taxane regimens with anthracycline vs. without anthracycline | Recurrence rates | 14% lower on average (RR 0·86, 95% CI 0·79-0·93; p=0·0004) |
| Taxane regimens with anthracycline vs. without anthracycline | Non-breast cancer deaths | Not increased, but there was one additional acute myeloid leukemia case per 700 women treated |
| Adding anthracycline concurrently to docetaxel plus cyclophosphamide vs. docetaxel plus cyclophosphamide | 10-year recurrence risk | 12·3% vs. 21·0%; risk difference 8·7%, 95% CI 4·5-12·9; RR 0·58, 0·47-0·73; p<0·0001 |
| Adding anthracycline concurrently to docetaxel plus cyclophosphamide vs. docetaxel plus cyclophosphamide | 10-year breast cancer mortality | Reduced by 4·2% (0·4-8·1; p=0·0034) |
| Sequential schedules of taxane plus anthracycline vs. docetaxel plus cyclophosphamide | Recurrence risk | No significant reduction (RR 0·94, 0·83-1·06; p=0·30) |
| Anthracycline regimens with taxane vs. without taxane | Recurrence reductions | Larger reductions seen from adding taxane to anthracycline regimens when the cumulative dose of anthracycline was the same in each group (RR 0·87, 0·82-0·93; p<0·0001; n=11 167) than in trials with two-fold higher cumulative doses of non-taxane (mostly anthracycline) in the control group than in the taxane group (RR 0·96, 0·90-1·03; p=0·27; n=14 620) |
| Anthracycline vs. taxane regimens | Efficacy | A higher cumulative dose and more dose-intense schedules were more efficacious |
| Anthracycline plus taxane regimens | Proportional reductions in recurrence | Similar in estrogen receptor-positive and estrogen receptor-negative disease, and did not differ by age, nodal status, or tumor size or grade |
- Other findings:
- Regimens with higher cumulative doses of anthracycline plus taxane provide the greatest benefits
- The proportional reductions in recurrence for taxane plus anthracycline were similar in estrogen receptor-positive and estrogen receptor-negative disease, and did not differ by age, nodal status, or tumor size or grade
- Summary: An individual patient-level meta-analysis of randomized trials comparing taxane regimens with versus without anthracycline, and anthracycline regimens with versus without taxane, found that anthracycline plus taxane regimens are most efficacious at reducing breast cancer recurrence and death. The clearest reductions in recurrence were found when anthracycline was added concurrently to docetaxel plus cyclophosphamide. Regimens with higher cumulative doses of anthracycline plus taxane provide the greatest benefits, challenging the current trend in clinical practice and guidelines towards non-anthracycline chemotherapy, particularly shorter regimens. This meta-analysis provides a reliable evidence base to inform individual treatment decisions, clinical guidelines, and the design of future clinical trials.