Anthracycline addition to taxane supported for early breast cancer
medwireNews: A patient-level meta-analysis has demonstrated a significant reduction in the risk for invasive recurrence with the use of an anthracycline alongside taxane-based chemotherapy for the treatment of early-stage breast cancer.
Presenting the findings at the 2021 San Antonio Breast Cancer Symposium, Jeremy Braybrooke (University of Oxford, UK) explained that the combination of anthracycline and taxane-based chemotherapy has previously been shown to reduce the risk for breast cancer-specific mortality by about a third versus no chemotherapy.
However, concerns regarding cardiovascular toxicity and leukemia with anthracyclines has led to increasing use of non-anthracycline-based chemotherapy, he added.
In order “to better characterise the benefits and risks” of anthracycline addition in the early breast cancer setting, Braybrooke and colleagues conducted a meta-analysis of individual data from over 18,000 participants of 16 trials.
Pooling the data from all trials showed that the recurrence risk was reduced by a significant 15% among patients who did versus did not receive an anthracycline in addition to taxane-based chemotherapy, while the risk for breast cancer-specific mortality was reduced by a significant 13%.
The 10-year rates of recurrence in the anthracycline plus taxane and taxane alone groups were 16.4% and 19.0%, respectively, and the corresponding breast cancer-specific mortality rates were 10.4% and 12.0%. Therefore, the absolute reductions in the recurrence and breast cancer-specific mortality risks with anthracycline use were 2.5 and 1.6 percentage points, respectively.
Categorization of the trials by their design showed that the reduction in recurrence risk appeared to be driven by the three studies (n=2469 patients) that compared six cycles of concurrent anthracycline, docetaxel, and cyclophosphamide with six cycles of the same dose of docetaxel plus cyclophosphamide. Specifically, the recurrence risk was reduced by a significant 42% with versus without the addition of anthracycline, while the absolute risk reduction was 8.7%.
By contrast, anthracycline use was not associated with a significant risk reduction in the eight trials (n=11,386) that compared sequential anthracycline and taxane with a higher cumulative dose of docetaxel plus cyclophosphamide.
And the findings were similar for breast cancer-specific mortality, reported Braybrooke.
He also shared data on toxicity, which showed “no difference in deaths from cardiovascular disease or leukemia” in the combined analysis of all trials, but Braybrooke stressed the need for longer-term follow-up.
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