Concurrent taxane plus anthracycline most beneficial in reducing risk of breast cancer

A meta-analysis based on data of 18,203 early-stage breast cancer patients demonstrated anthracycline plus taxane to reduce the risk of breast cancer recurrence by 15% compared with taxane alone. The treatment did not significantly increase number of deaths from cardiovascular disease or leukaemia.

Anthracycline-containing and taxane-containing chemotherapy regimens reduce the rate of early-stage breast cancer recurrence by about a third compared with no chemotherapy. However, concerns about the increased risks of cardiac toxicity and leukaemia have resulted in treatment regimens without anthracycline. To better characterise the benefits and risks of anthracycline and taxane chemotherapy in early-stage breast cancer patients, a meta-analysis was performed based on individual data of 18,203 participants from 16 randomised-controlled trials starting before 2010. All trials included at least 6 cycles of chemotherapy in each arm. Primary outcomes were recurrence and cause-specific mortality. Dr Jeremy Braybrooke (University Hospitals Bristol NHS Foundation Trust, UK) presented the results [1].

Three trials compared 6 courses of concurrent anthracycline, docetaxel, and cyclophosphamide versus docetaxel and cyclophosphamide alone; 8 trials compared sequential anthracycline plus taxane versus higher cumulative dose of docetaxel plus cyclophosphamide; 3 trials compared anthracycline plus taxane versus higher cumulative dose of taxane ± capecitabine; and 2 trials compared anthracycline plus taxane versus higher cumulative dose of taxane plus carboplatin.

Results show that patients treated with an anthracycline and taxane combination had on average 15% lower rates of breast cancer recurrence (RR 0.85; P=0.0003) than those receiving a taxane schedule without anthracycline, with an absolute reduction of 3.1% in 10-year recurrence (16.4% vs 19.0%). The 10-year risk of death from breast cancer was reduced by 1.6% (10.4% vs 12.0%; RR 0.87; P=0.02). The proportional reduction in recurrence was greatest in the 6 trials of concurrent anthracycline, docetaxel, and cyclophosphamide versus docetaxel plus cyclophosphamide (RR 0.58). By contrast, in trials of sequential anthracycline plus taxane versus the higher cumulative dose of docetaxel plus cyclophosphamide, no significant benefit from anthracycline was detected (RR 0.92). Also for breast cancer mortality, concurrent anthracycline plus taxane (vs taxane alone RR 0.65; 95% CI 0.49–0.87; P=0.003) outperformed sequential anthracycline plus taxane (vs taxane alone RR 0.91; 95% CI 0.76–1.08; P=0.28; see Figure).

Figure: Breast cancer mortality in concurrent (left) versus sequential (right) treatment [1].



 

 

 

 

 

No significant increases in deaths without recurrence or death from cardiovascular disease or leukaemia were observed, though longer follow-up is needed to fully assess the risks. Individual patient level data on toxicity and/or quality of life were not available.

“This meta-analysis demonstrates that the addition of anthracycline to taxane chemotherapy, compared with taxane alone, reduced the risk of breast cancer recurrence by 15% with larger proportional reductions in trials of concurrent anthracycline compared with sequential anthracycline. In addition, anthracycline did not significantly increase death from cardiovascular disease or leukaemia,” summarised Dr Braybrooke.

1. Braybrooke J, et al. Taxane with anthracycline versus taxane without anthracycline: An individual patient-level meta-analysis of 16,500 women with early-stage breast cancer in 13 randomised trials. GS2-06, SABCS 2021 Virtual Meeting, 7–10 December.

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Posted on 31 January, 2022