> Table 40: Different adjuvant chemotherapy combinations and overall survival in early breast cancer
This summary table contains detailed information about research studies. Summary tables offer an informative look at the science behind many breast cancer guidelines and recommendations. However, they should be viewed with some caution. In order to read and interpret research tables successfully, it is important to understand some key concepts. Learn how to read a research table.
|
Introduction: Many chemotherapy drug combinations can be used to treat early breast cancer. More and more, treatment is tailored to benefit each person's breast cancer. There is ongoing research to learn which chemotherapy combinations are the most effective for specific types of tumors.
Chemotherapy containing an anthracycline
Cyclophosphamide, methotrexate and fluoruoracil (CMF) is a well-studied chemotherapy drug combination. The Early Breast Cancer Trialists’ Collaborative Group combined the results of 17 randomized clinical trials that compared CMF to combinations that included an anthracycline drug. They found drug combinations containing an anthracycline improved overall survival (about three percent at five years and four percent at 10 years) [1].
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 an anthracycline plus a taxane
Two meta-analyses have combined the results of randomized clinical trials comparing chemotherapy containing an anthracycline plus a taxane (such as paclitaxel or docectaxel) to chemotherapy that did not include a taxane [2-3]. Both meta-analyses found an increase in five-year overall survival when chemotherapy included a taxane. The Cochrane Collaboration combined the results of 11 studies (that together included 18,304 women) and found a 20 percent decrease in the risk of dying within five years when chemotherapy included a taxane [3].
Learn more about chemotherapy drugs.
For information on treatment of HER2/neu-positive breast cancers, see Table 43.
Learn about the strengths and weaknesses of different types of studies.
Study selection criteria: 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* [1]
|
Overall
|
77%
|
73%
|
4%
|
| |
Women younger than 45 years
|
74%
|
71%
|
3%
|
| |
Women 45-54
|
78%
|
77%
|
1%
|
| |
Women 55-69 years
|
81%
|
79%
|
2%
|
| |
Women 70 years or older
|
83%
|
78%
|
5%
|
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 |
Pooled and meta-analyses
|
Early Breast Cancer Trialists’ Collaborative Group† [1]
|
84%
|
82%
|
2%‡
|
De Laurentiis et al.‡, § [2]
|
77%
|
74%
|
3%
|
* Combined individual data from 18,000 women in 20 randomized clinical trials
† Combined individual data from 44,000 women in 33 randomized clinical trials
‡ Absolute improvement in survival after eight years was three percent
§ Combined results from 13 randomized clinical trials that together included 22,903 women
References
1. Peto R, Davies C, Godwin J, et al. for the Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials. Lancet. 379(9814):432-44, 2012.
2. 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.
3. 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 01/22/13
