Choosing a taxane for adjuvant treatment of breast cancer: more than a flip of the coin?

This Practice Point commentary discusses the findings of a trial that assessed the efficacy of weekly (QW) versus once every 3 weeks (Q3W) paclitaxel or docetaxel after doxorubicin-and-cyclophosphamide-based chemotherapy in patients with node-positive or high-risk node-negative breast cancer. There were several analyses in this trial, the first comparing docetaxel with paclitaxel and the second assessing the impact of schedule of chemotherapy. In an intention to treat analysis, there was no difference in disease-free survival between the two taxanes or between the two dosing schedules. When the four arms of the trial were assessed individually, however, QW paclitaxel was superior to Q3W paclitaxel with respect to disease-free survival (P = 0.006) and overall survival (P = 0.01). Patients on the QW paclitaxel schedule had a greater incidence of grade 2, 3 or 4 peripheral neuropathy than did those on Q3W paclitaxel (27% vs 20%). This study further elucidates the nuances in taxane therapy and supports the concept that attenuating the interval between chemotherapy treatments might lead to improved outcome.