> Table 39: Different adjuvant chemotherapy combinations and overall survival in early breast cancer
This summary table contains detailed information about research studies. While viewing summary tables offers an informative glimpse at the science behind many breast cancer guidelines and recommendations, they should be viewed with some caution. There are a number of concepts you must understand to be able to successfully read and interpret research tables. To get some background information about understanding research tables, please see How to Read a Research Table.
|
Introduction: Many chemotherapy drug combinations can be used to treat early breast cancer.
Chemotherapy containing an anthracycline
Cyclophosphamide, methotrexate and fluoruoracil (CMF) is one of the most well-studied chemotherapy drug combinations. The Early Breast Cancer Trialists’ Collaborative Group combined the results of 17 randomized clinical trials that compared the effectiveness of CMF to combinations that include an anthracycline drug. They found that drug combinations that contained an anthracycline could improve overall survival (about three percent at five years and four percent at 10 years) [1,2].
Common chemotherapy combinations that include an anthracycline have one or more of the following drugs:
- Cyclophosphamide (Cytoxan)
- Docetaxel (Taxotere)
- Doxorubicin (Adriamycin)
- Epirubicin (Pharmorubicin)
- Fluorouracil (5-FU)
- Methotrexate (Trexall)
- Paclitaxel (Taxol)
Chemotherapy containing a taxane
Two studies have combined results of randomized clinical trials comparing the effectiveness of chemotherapy that contained an anthracycline plus a taxane, such as paclitaxel (Taxol) or docectaxel (Taxotere), to chemotherapy that did not include a taxane [3,4]. Both studies found an increase in five-year overall survival when a taxane was added. The Cochrane Collaboration combined the results of 11 studies (including 18,304 women) and found a 20 percent decrease in the risk of dying in five years when a taxane was added to chemotherapy [4].
There is ongoing research to learn which chemotherapy combinations are the most effective for specific types of tumors. More and more, treatment is tailored to benefit each person’s breast cancer.
For information on treatment of HER2/neu-positive breast cancers, see Table 42.
Learn about the strengths and weaknesses of different types of studies.
Study selection criteria: Latest Early Breast Cancer Trialists' Collaborative Group pooled analysis and other pooled and meta-analyses.
Chemotherapy with an Anthracycline
|
| |
10-Year Overall Survival
|
Study
|
Study Population |
Percent Surviving—
Chemotherapy with an
Anthracycline
|
Percent Surviving—
CMF Chemotherapy (No Anthracycline)
|
Absolute Improvement in Survival with Chemotherapy Containing Anthracycline Compared to Chemotherapy Not Containing an Anthracycline
|
Pooled analyses
|
|
Early Breast Cancer Trialists’ Collaborative Group* [2]
|
Overall
|
67.6%
|
63.5%
|
4.1%
|
| |
Women <50 years
|
74.4%
|
71.2%
|
3.2%
|
|
Women 50-69 years
|
75.6%
|
73.0%
|
2.6%
|
|
Women 70 years or older
|
85.6%
|
74.3%
|
11.3%
|
| Chemotherapy with an Anthracycline Plus a Taxane |
|
5-Year Overall Survival
|
Study
|
Percent Surviving—
Chemotherapy with an
Anthracycline Plus a Taxane
|
Percent Surviving—
Chemotherapy with an
Anthracycline (No Taxane)
|
Absolute Improvement in Survival with Chemotherapy Containing a Taxane Compared to Chemotherapy Not Containing a Taxane |
Meta-analyses
|
De Laurentiis et al.† [3]
|
77%
|
74%
|
3%
|
* A combination of data from 17 randomized clinical trials that together included 14,471 women.
† A combination of results from 13 randomized clinical trials that together included 22,903 women.
References
1. Early Breast Cancer Trialists' Collaborative Group. Polychemotherapy for early breast cancer: an overview of the randomised trials. Lancet. 352:930-42, 1998.
2. Early Breast Cancer Trialists' Collaborative Group. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomized trials. Lancet. 365(9472):1687-717, 2005.
3. De Laurentiis M, Cancello G, D'Agostino D, et al. Taxane-based combinations as adjuvant chemotherapy of early breast cancer: a meta-analysis of randomized trials. J Clin Oncol. 26(1):44-53, 2008.
4. Ferguson T, Wilcken N, Vagg R, Ghersi D, Nowak AK. Taxanes for adjuvant treatment of early breast cancer. Cochrane Database Syst Rev. (4):CD004421, 2007.
Updated 03/10/10
