This article is more than 5 years old. Information may no longer be current.
Sequential anthracycline-cyclophosphamide, taxane regimen ‘most effective’ adjuvant therapy for early-stage breast cancer
Click Here to Manage Email Alerts
Sequential anthracycline-cyclophosphamide and taxane may serve as the best available adjuvant therapy regimen for early-stage breast cancer regardless of hormone receptor status, according to the results of a systemic review and network meta-analysis.
Many different adjuvant chemotherapy regimens exist for early-stage breast cancer; however, a conventional meta-analysis would not allow for comparison of all of these regimens, according to researchers.
“It is well established that adjuvant chemotherapy plays an important role in reducing the risk for recurrence and improving the survival of patients with breast cancer,” Naoto T. Ueno, MD, PhD, chief of the section of translational breast cancer research at The University of Texas MD Anderson Cancer Center, and colleagues wrote. “The National Comprehensive Cancer Network guidelines for the treatment of breast cancer describe numerous recommended adjuvant chemotherapy regimens … of them, sequential anthracycline-cyclophosphamide and taxane (AC-T) is the most commonly accepted standard regimen. However, two types of regimens without anthracyclines may have efficacy similar to or greater than that of sequential AC-T.”
Ueno and colleagues performed a network meta-analysis to identify the most effective adjuvant chemotherapy regimen. Researchers searched MEDLINE, Embase and the Cochrane Library for articles published prior to June 2015, as well as ASCO Annual Meeting abstracts from January 1983 to December 2014 and American Association for Cancer Research Annual Meeting abstracts from January 1916 to December 2014. Further, they manually searched bibliographies for related references.
The network meta-analysis included 24 randomized clinical trials of adjuvant treatments for early-stage breast cancer that compared two or more of the following treatment regimens: no adjuvant chemotherapy; sequential AC-T; concurrent anthracycline-cyclophosphamide and taxane (ACT); anthracycline-cyclophosphamide without taxane (AC); docetaxel and cyclophosphamide (TC); cyclophosphamide, methotrexate and fluorouracil (CMF); and platinum-containing regimens.
Determining the most effective adjuvant therapy regimen in terms of OS served as the primary endpoint.
TC (HR = 0.93; 95% CI, 0.62-1.4) and platinum-containing regimens (HR = 0.93; 95% CI, 0.66-1.31) had OS benefit similar to sequential AC-T.
However, CMF (HR = 1.56; 95% CI, 1.32-1.85) and AC (HR = 1.22; 95% CI, 1.1-1.37) appeared associated with significantly poorer OS outcomes.
Platinum-containing regimens tended to be more toxic than sequential AC-T, whereas the toxicity profile of TC appeared similar to or less than that of sequential AC-T.
The researchers performed a meta-regression analysis that showed that hormone receptor status did not impact the HRs for OS for any regimen.
Study limitations included the grouping of several different sequential anthracycline and taxane regimens and regimens with different drug doses, as well as the exclusion of trials targeting patients with HER-2–positive tumors. Further, five trials had a median follow-up of less than 60 months, including one trial where median follow-up was not reported.
“Further clinical studies may be required to investigate target markers that will predict patients with a higher likelihood of response to platinum-containing regimens,” Ueno and colleagues wrote. “Sequential AC-T is likely to be the most effective adjuvant treatment for early-stage breast cancer regardless of hormone receptor status.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts