eBCa: should anthracyclines precede taxanes? A Cochrane review

  • Cochrane Database Syst Rev

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • A Cochrane review finds that the sequence in which neoadjuvant anthracycline and taxane chemotherapy are delivered has no bearing on OS, DFS, treatment adherence, and adverse events.

Why this matters

  • The authors state that the evidence does not support changing the standard of care (anthracycline-based chemotherapy followed by a taxane) for early breast cancer (eBCa).

Study design

  • Review and meta-analysis of 9 randomized controlled trials (RCTs; n=1695), with 5 RCTs of neoadjuvant therapy (n=1415) and 4 of adjuvant therapy (n=280) for eBCa.
  • Primary outcome was OS.
  • Funding: University of Sydney, Australia; National Institute for Health Research.

Key results

  • Neoadjuvant RCTs comparing taxanes followed by anthracyclines with anthracyclines followed by taxanes found no difference in these outcomes:
    • OS:  HR, 0.80; 95% CI, 0.60-1.08; 2 RCTs; moderate certainty.
    • DFS: HR, 0.84; 95% CI, 0.65-1.09; 1 RCT: moderate certainty.
    • Pathologic complete response: no difference, risk ratio (RR), 1.15; 95% CI, 0.96-1.38; 4 RCTs; high certainty with trend favoring taxanes first.
    • Treatment adherence: RR, 0.81; 95% CI, 0.59-1.11; 1 RCT; moderate certainty.
    • Grade 3/4 neutropenia: RR, 1.25; 95% CI, 0.86-1.82; 1 RCT; moderate certainty.
    • Grade 3/4 neurotoxicity: RR, 0.95; 95% CI, 0.55-1.65; 2 RCTs; low certainty.

Limitations

  • The single adjuvant study did not have OS as a primary outcome.
  • Few studies/patients.

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