Wanjing Chen1, Qian Tu1, Yanfei Shen2, Kejun Tang3, Mengying Hong4, Yong Shen5. 1. Department of General Surgery, The Second Hospital of Anhui Medical University, Hefei, 230601, Anhui, China. 2. Department of Intensive Care Unit, Zhejiang Hospital, Zhejiang, 322100, Hangzhou, China. 3. Department of Surgery, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China. 4. Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310009, Hangzhou, China. 5. Department of Breast Surgery, The First Affiliated Hospital, Zhejiang Chinese Medical University, Zhejiang, 310006, Hangzhou, China. shenyong@zcmu.edu.cn.
Abstract
BACKGROUND: Whether a sequential or concurrent regimen of anthracyclines and taxanes is superior for breast cancer is controversial. We compared the efficacy of two regimens in patients with operable breast cancer based on all relevant published data of phase III randomized controlled trials. METHODS: A comprehensive literature search on PubMed, Web of Science, Embase, ScienceDirect, Google Scholar, and ClinicalTrials.gov databases was performed up to May 2020. Meta-analysis was performed to evaluate the different efficacy on disease-free survival (DFS) and overall survival (OS) for the two chemotherapy regimens. Subgroup analyses were further carried out in terms of node status and anthracycline selection. RESULTS: Compared to the concurrent regimen, the sequential regimen did not improve the DFS or OS in the population studied. Subgroup analysis showed that in node-positive patients, the sequential regimen had better DFS, but not OS, than the concurrent regimen. In sequential regimen, patients who received doxorubicin and taxanes had improved DFS and OS than patients who were administered epirubicin and taxanes. Furthermore, for patients who received doxorubicin and taxanes, compared to the sequential regimen, fewer cycles (4 cycles) of concurrent treatment resulted in a worse DFS and OS, which can be rescued by more cycles (6 cycles). CONCLUSIONS: The sequential regimen of anthracyclines and taxanes for patients with operable breast cancer did not yield a significant benefit in DFS or OS over the concurrent regimen. The sequential regimen, however, provided a better DFS than concurrent regimen for node-positive patients. Interestingly, further subgroup analysis showed that for node-positive patients who were given doxorubicin and taxanes, more cycles (6 cycles) of the concurrent regimen may rescue the efficacy for fewer cycles (4 cycles).
BACKGROUND: Whether a sequential or concurrent regimen of anthracyclines and taxanes is superior for breast cancer is controversial. We compared the efficacy of two regimens in patients with operable breast cancer based on all relevant published data of phase III randomized controlled trials. METHODS: A comprehensive literature search on PubMed, Web of Science, Embase, ScienceDirect, Google Scholar, and ClinicalTrials.gov databases was performed up to May 2020. Meta-analysis was performed to evaluate the different efficacy on disease-free survival (DFS) and overall survival (OS) for the two chemotherapy regimens. Subgroup analyses were further carried out in terms of node status and anthracycline selection. RESULTS: Compared to the concurrent regimen, the sequential regimen did not improve the DFS or OS in the population studied. Subgroup analysis showed that in node-positive patients, the sequential regimen had better DFS, but not OS, than the concurrent regimen. In sequential regimen, patients who received doxorubicin and taxanes had improved DFS and OS than patients who were administered epirubicin and taxanes. Furthermore, for patients who received doxorubicin and taxanes, compared to the sequential regimen, fewer cycles (4 cycles) of concurrent treatment resulted in a worse DFS and OS, which can be rescued by more cycles (6 cycles). CONCLUSIONS: The sequential regimen of anthracyclines and taxanes for patients with operable breast cancer did not yield a significant benefit in DFS or OS over the concurrent regimen. The sequential regimen, however, provided a better DFS than concurrent regimen for node-positive patients. Interestingly, further subgroup analysis showed that for node-positive patients who were given doxorubicin and taxanes, more cycles (6 cycles) of the concurrent regimen may rescue the efficacy for fewer cycles (4 cycles).
Entities:
Keywords:
Anthracycline; Breast cancer; Concurrent regimen; Sequential regimen; Taxanes
Authors: D R Budman; D A Berry; C T Cirrincione; I C Henderson; W C Wood; R B Weiss; C R Ferree; H B Muss; M R Green; L Norton; E Frei Journal: J Natl Cancer Inst Date: 1998-08-19 Impact factor: 13.506
Authors: William J Gradishar; Benjamin O Anderson; Ron Balassanian; Sarah L Blair; Harold J Burstein; Amy Cyr; Anthony D Elias; William B Farrar; Andres Forero; Sharon Hermes Giordano; Matthew P Goetz; Lori J Goldstein; Steven J Isakoff; Janice Lyons; P Kelly Marcom; Ingrid A Mayer; Beryl McCormick; Meena S Moran; Ruth M O'Regan; Sameer A Patel; Lori J Pierce; Elizabeth C Reed; Kilian E Salerno; Lee S Schwartzberg; Amy Sitapati; Karen Lisa Smith; Mary Lou Smith; Hatem Soliman; George Somlo; Melinda Telli; John H Ward; Dorothy A Shead; Rashmi Kumar Journal: J Natl Compr Canc Netw Date: 2017-04 Impact factor: 11.908
Authors: C Oakman; P A Francis; J Crown; E Quinaux; M Buyse; E De Azambuja; M Margeli Vila; M Andersson; B Nordenskjöld; R Jakesz; B Thürlimann; J Gutiérrez; V Harvey; L Punzalan; P Dell'orto; D Larsimont; I Steinberg; R D Gelber; M Piccart-Gebhart; G Viale; A Di Leo Journal: Ann Oncol Date: 2013-01-04 Impact factor: 32.976
Authors: I Craig Henderson; Donald A Berry; George D Demetri; Constance T Cirrincione; Lori J Goldstein; Silvana Martino; James N Ingle; M Robert Cooper; Daniel F Hayes; Katherine H Tkaczuk; Gini Fleming; James F Holland; David B Duggan; John T Carpenter; Emil Frei; Richard L Schilsky; William C Wood; Hyman B Muss; Larry Norton Journal: J Clin Oncol Date: 2003-03-15 Impact factor: 44.544
Authors: Norihiro Yamaguchi; Takeo Fujii; Shunsuke Aoi; Peter S Kozuch; Gabriel N Hortobagyi; Ronald H Blum Journal: Eur J Cancer Date: 2015-09-03 Impact factor: 9.162
Authors: R Peto; C Davies; J Godwin; R Gray; H C Pan; M Clarke; D Cutter; S Darby; P McGale; C Taylor; Y C Wang; J Bergh; A Di Leo; K Albain; S Swain; M Piccart; K Pritchard Journal: Lancet Date: 2011-12-05 Impact factor: 79.321
Authors: H M Earl; L Hiller; J A Dunn; S Bathers; P Harvey; A Stanley; R J Grieve; R K Agrawal; I N Fernando; A M Brunt; K McAdam; S O'Reilly; D W Rea; D Spooner; C J Poole Journal: Br J Cancer Date: 2008-09-16 Impact factor: 7.640