Addition of taxanes improves survival outcomes with anthracyclines

The addition of a taxane to anthracycline-based treatments improves disease free and overall survival in patients with high risk early breast cancer, a meta-analysis shows Taxane and anthracycline combinations for first line treatments for breast cancer have been shown to improve response rates and time to progression. Their use as adjuvant treatment is controversial, and not all studies have found an improvement in overall survival. This meta-analysis included 22,903 patients taking part in 13 randomised trials that compared taxanes and anthracycline regimes with anthracycline-based treatments for early breast cancer. There were 5,829 recurrences and 3.329 deaths. There was a significant decrease in risk of recurrence, and no difference between type of taxanes given. Pooled HR for disease free survival was 0.83 (95% CI, 0.79 to 0.87; p < .00001) and for overall survival was 0.85 (95% CI, 0.79 to 0.91; P < .00001). This was equivalent to a 5-year absolute risk reduction of 5% for disease free survival and 3% for overall survival. Specific subgroups of patients were also analysed, where available. These included comparing oestrogen receptor positive or negative disease (in 10 studies of 17,324 patients) , nodal status of 1-3 compared with 4+ nodes (in 4 trials of 6,179 patients), age greater or less than 50 years (3 trials) , premenopausal compared with menopausal status (2 trials), and HER-2 positive or negative tumours ( 2 studies). There was no statistically significant difference in the hazard ratios between these subgroups of patients. Sensitivity analysis showed that taxanes in combination with anthracyclines did not significantly improve overall survival, and there was heterogeneity between trials. However, the test for interaction showed that HR did not differ between the combination or sequential administration of anthracyclines, and the authors noted that randomised comparisons are needed to show the differences. The authors noted that as the benefit in disease free survival was independent of oestrogen receptor expression, degree of nodal involvement, type of taxane, age or menopausal status of the patients, these factors should not be used to identify patients who may or may not benefit from taxane therapy. Reference...