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Controversies in the management of adjuvant breast cancer with taxanes: Review of the current literature

      Summary

      Taxanes offer clear benefits in adjuvant chemotherapy for early breast cancer. This review examines evidence to date on the clinical effectiveness and cost-effectiveness of their use in the adjuvant treatment of women with early breast cancer, based on three meta-analyses, one systematic review, five clinical practice guidelines and 16 randomized clinical trials. Against the background of a major increase in the use of docetaxel rather than paclitaxel in our setting over the past few years, implying a major increase in costs, we examined whether this higher use of docetaxel is supported by the available evidence. In this wide study, we found no evidence that regimens containing docetaxel yield greater benefits than those including paclitaxel. From an effectiveness standpoint, the change from paclitaxel to docetaxel in our setting is not justified.

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      References

        • Henderson I.C.
        • Berry D.A.
        • Demetri G.D.
        • et al.
        Improved outcomes from adding sequential paclitaxel but not from escalating doxorubicin dose in an adjuvant chemotherapy regimen for patients with node-positive primary breast cancer.
        J Clin Oncol. 2003; 21: 976-983
        • Mamounas E.P.
        • Bryant J.
        • Lembersky B.
        • et al.
        Paclitaxel after doxorubicin plus cyclophosphamide as adjuvant chemotherapy for node-positive breast cancer: results from NSABP B-28.
        J Clin Oncol. 2005; 23: 3686-3696
        • Martin M.
        • Pienkowski T.
        • Mackey J.
        • et al.
        Adjuvant docetaxel for node-positive breast cancer.
        N Engl J Med. 2005; 352: 2302-2313
        • Roche H.
        • Fumoleau P.
        • Spielmann M.
        • et al.
        Sequential adjuvant epirubicin-based and docetaxel chemotherapy for node-positive breast cancer patients: the FNCLCC PACS 01 Trial.
        J Clin Oncol. 2006; 24: 5664-5671
        • Citron M.L.
        • Berry D.A.
        • Cirrincione C.
        • et al.
        Randomized trial of dose-dense versus conventionally scheduled and sequential versus concurrent combination chemotherapy as postoperative adjuvant treatment of node-positive primary breast cancer: first report of Intergroup Trial C9741/Cancer and Leukemia Group B Trial 9741.
        J Clin Oncol. 2003; 21: 1431-1439
      1. Docetaxel for the adjuvant treatment of early node-positive breast cancer. Technology appraisal guidance 109. Paclitaxel for the adjuvant treatment of early node-positive breast cancer. Technology appraisal guidance 106. 2006 Guidelines.

        • Harnett A.
        • Smallwood J.
        • Titshall V.
        • Champion A.
        • Guideline Development Group
        Diagnosis, treatment of early breast cancer, including locally advanced disease-summary of NICE guidance.
        BMJ. 2009; 338: 438
      2. NCCN Clinical Practice Guidelines in Oncology. v.1.2009.

      3. Trudeau M, Eisen A, Messersmith H, et al. Adjuvant taxane therapy for women with early-stage, invasive breast cancer: a clinical practice guideline. CCO 2006 Practice Guideline.

        • Kataja V.
        • Castiglione M.
        • ESMO Guidelines Working Group
        Primary breast cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up.
        Ann Oncol. 2009; 4: 10-14
      4. BC Agency 2007 Guidelines.

        • Buzdar A.U.
        • Singletary S.E.
        • Valero V.
        • et al.
        Evaluation of paclitaxel in adjuvant chemotherapy for patients with operable breast cancer: preliminary data of a prospective randomized trial.
        Clin Cancer Res. 2002; 8: 1073-1079
        • Jones S.E.
        • Savin M.A.
        • Holmes F.A.
        • et al.
        Phase III trial comparing doxorubicin plus cyclophosphamide with docetaxel plus cyclophosphamide as adjuvant therapy for operable breast cancer.
        J Clin Oncol. 2006; 24: 5381-5387
        • Francis P.
        • Crown J.
        • Di Leo A.
        • et al.
        • BIG 02-98 Collaborative Group
        Adjuvant chemotherapy with sequential or concurrent anthracycline and docetaxel: Breast International Group 02-98 randomized trial.
        J Natl Cancer Inst. 2008; 100: 121-133
        • Martín M.
        • Rodríguez-Lescure A.
        • Ruiz A.
        • et al.
        • GEICAM 9906 Study Investigators
        Randomized phase 3 trial of fluorouracil, epirubicin, and cyclophosphamide alone or followed by paclitaxel for early breast cancer.
        J Natl Cancer Inst. 2008; 100: 805-814
        • Gianni L.
        • Baselga J.
        • Eiermann W.
        • et al.
        Phase III trial evaluating the addition of paclitaxel to doxorubicin followed by cyclophosphamide, methotrexate, and fluorouracil, as adjuvant or primary systemic therapy: European Cooperative Trial in Operable Breast Cancer.
        J Clin Oncol. 2009; 27: 2474-2481
        • Sparano J.A.
        • Wang M.
        • Martino S.
        • Jones
        • et al.
        Weekly paclitaxel in the adjuvant treatment of breast cancer.
        N Engl J Med. 2008; 358: 1663-1671
        • Fountzilas G.
        • Skarlos D.
        • Dafni U.
        • et al.
        Postoperative dose-dense sequential chemotherapy with epirubicin, followed by CMF with or without paclitaxel, in patients with high-risk operable breast cancer: a randomized phase III study conducted by the Hellenic Cooperative Oncology Group.
        Ann Oncol. 2005; 16: 1762-1771
        • Bianco A.R.
        • De Matteis A.
        • Manzione L.
        • et al.
        Sequential epirubicin–docetaxel–CMF as adjuvant therapy of early breast cancer: results of the Taxit216 multicenter phase III trial.
        J Clin Oncol. 2006; 24: 18s
        • Goldstein L.J.
        • O’Neill A.
        • Sparano J.A.
        • Perez
        • et al.
        Concurrent doxorubicin plus docetaxel is not more effective than concurrent doxorubicin plus cyclophosphamide in operable breast cancer with 0 to 3 positive axillary nodes: North American Breast Cancer Intergroup Trial E 2197.
        J Clin Oncol. 2008; 26: 4092-4099
        • Ellis P.
        • Barrett-Lee P.
        • Johnson L.
        • et al.
        • TACT Trial Management Group
        TACT Trialists. Sequential docetaxel as adjuvant chemotherapy for early breast cancer (TACT): an open-label, phase III, randomised controlled trial.
        Lancet. 2009; 373: 1681-1692
        • Burnell M.
        • Levine M.N.
        • Chapman J.A.
        • et al.
        Cyclophosphamide, epirubicin, and fluorouracil versus dose-dense epirubicin and cyclophosphamide followed by paclitaxel versus doxorubicin and cyclophosphamide followed by paclitaxel in node-positive or high-risk node-negative breast cancer.
        J Clin Oncol. 2010; 28: 77-82
      5. Ferguson T, Wilcken N, Vagg R, et al. Taxanes for adjuvant treatment of early breast cancer. Cochrane Database Syst Rev 2007;(4).

        • De Laurentiis M.
        • Cancello G.
        • D’Agostino D.
        • et al.
        Taxane-based combinations as adjuvant chemotherapy of early breast cancer: a meta-analysis of randomized trials.
        J Clin Oncol. 2008; 26: 44-53
        • Bria E.
        • Nistico C.
        • Cuppone F.
        • et al.
        Benefit of taxanes as adjuvant chemotherapy for early breast cancer: pooled analysis of 15,500 patients.
        Cancer. 2006; 106: 2337-2344
        • Ward S.
        • Simpson E.
        • Davis S.
        • Hind D.
        • Rees A.
        • Wilkinson A.
        Taxanes for the adjuvant treatment of early breast cancer: systematic review and economic evaluation.
        Health Technol Assess. 2007; 11: 1-144