Overall survival benefit for weekly vs. three-weekly taxanes regimens in advanced breast cancer: A meta-analysis
Received 27 August 2009; received in revised form 26 October 2009; accepted 27 October 2009. published online 30 November 2009.
Summary
Background
Taxanes have been extensively tested in patients with advanced breast cancer, but it is unclear whether their weekly use might offer any benefits against standard every three weeks administration. We therefore performed a meta-analysis of randomized controlled trials that compared weekly and every three weeks taxanes regimens in advanced breast cancer.
Methods
The endpoints that we assessed were objective response rate, progression free survival (PFS) and overall survival. Efficacy data for paclitaxel and docetaxel were separately analyzed. Trials were located through PubMed and Cochrane Library searches and abstracts of major international conferences.
Results
Οbjective response rate was notably better when paclitaxel was used as every three weeks regimen (7 studies, 1772 patients, fixed effect model pooled RR 1.20 95%CI 1.08–1.32 p<0.001). No difference were found for PFS (6 studies, 1610 patients, random effect model HR 1.02, 95%CI 0.81–1.30 p=0.860); while OS was statistically higher among patients receiving weekly paclitaxel (5 studies, 1471 patients, fixed effect model pooled HR 0.78, 95%CI 0.67–0.89 p=0.001). No differences were observed for the weekly compared to the every three weeks use of docetaxel either for objective response, PFS and OS. Overall, the incidence of serious adverse events, neutropenia, neutropenic fever, and peripheral neuropathy were significantly lower in weekly taxanes schedules. The incidence of nail changes and epiphora were significantly lower in the every three weeks docetaxel regimens.
Conclusions
Use of paclitaxel in weekly regimen give overall survival advantages compared with the standard every three weeks regimen. The observed survival benefit does not seem to stem from an increased potency of the drug with weekly regimens. The use of weekly paclitaxel regimens is therefore recommended for the treatment of locally advanced/metastatic breast cancer.
aDepartment of Medical Oncology, General Hospital of Lamia, Lamia, Greece
bPanhellenic Association for Continual Medical Research (PACMeR), Greece
cDepartment of Obstetric and Gynecology, University Hospital of Larisa, Greece
Corresponding author. Address: Department of Medical Oncology, General Hospital of Lamia, Daravelia 23, Roditsa-Lamias, TK 35100, Lamia, Greece. Tel.: +30 694 55 62 573.
ABSTRACT