Nicholas R.C. Wilcken, MD, PhD; Martin R. Stockler, MD, MSc
In women with early breast cancer, how do adjuvant chemotherapy regimens compare for reducing breast cancer mortality?
Included trials compared taxane-based; anthracycline-based; and cyclophosphamide, methotrexate, and fluorouracil (CMF)–based chemotherapy regimens with each other or with no adjuvant chemotherapy in early breast cancer, and provided individual patient data. Trials of intensive chemotherapy with stem cell rescue or that compared only variations in dose density were excluded. Outcomes included breast cancer mortality and recurrence, and overall mortality.
Individual patient meta-analyses of 123 randomized controlled trials (RCTs) beginning in 1973 to 2003 (n = 100 000).
The main results for breast cancer mortality are in the Table.
In women with early breast cancer, taxane-plus-anthracycline–based regimens or anthracycline-based regimens reduce 10-year breast cancer mortality rates by about one third, largely irrespective of age (up to at least 70 y), stage, differentiation, estrogen receptor status, or use of endocrine therapy.
Comparison of chemotherapy regimens for mortality in early breast cancer (outcome = breast cancer mortality)*
*Anth = anthracycline; CEF= 6 cycles of cyclophosphamide 75 x 14, eprubicin 60 x 2, fluorouracil 500 x 2, given 4 times weekly; CTX = chemotherapy; other abbreviations defined in Glossary. Chemotherapy regimens defined in footnotes are presented as drug dose, mg/m2 x frequency/cycle.
†RRRs and NNTs are calculated from numbers of events and risk ratios. Proportional reductions and 95% CIs calculated from the log-rank statistic O-E and its variance V are available from the authors. NNTs depend directly on the event rates in the comparator and the RRR with the CTX regimen.
‡4-taxane + anth = 4 cycles of taxane added to an anth-based regimen, extending treatment duration.
§S-4AC = 4 cycles of adriamycin 60, cyclophosphamide 600, IV, given 3 times weekly.
||CMF = 6 cycles of cyclophosphamide 100 x 14, methotrexate 40 x 2, fluorouracil 500 x 2, given 4 times weekly.
¶> S-4AC = CAF/CEF with adriamycin 360 or epirubicin 720 to 800.
**CAF = 6 cycles of cyclophosphamide 100 x 14, adriamycin 30 x 2, fluorouracil 500 x 2, given 4 times weekly.
††S-4EC = 4 cycles of epirubicin 90, cyclophosphamide 600, IV, 3 times weekly.
Wilcken NR, Stockler MR. Individual patient meta-analysis: Taxane plus anthracycline reduces mortality from early breast cancer. Ann Intern Med. ;156:JC6–4. doi: 10.7326/0003-4819-156-12-201206190-02004
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Published: Ann Intern Med. 2012;156(12):JC6-4.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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