Taxane with or without anthracycline reduces the recurrence rate of early-stage breast cancer. A meta-analysis based on data of 18,203 participants now demonstrates anthracycline/taxane to reduce the risk of breast cancer recurrence by 15%, compared with taxane alone. No significant increase in death from cardiovascular disease or leukemia was observed.

Anthracycline and taxane-containing chemotherapy regimens reduce the rate of early-stage breast cancer recurrence by about a third compared with no chemotherapy. However, concerns about the increased risks of cardiac toxicity and leukemia with anthracyclines have resulted in wider use of taxane chemotherapy schedules without anthracycline, in particular docetaxel/cyclophosphamide. The benefits and risks of this approach have been assessed in several randomized trials but with conflicting results. To better characterize the benefits and risks of anthracycline and taxane chemotherapy in early-stage breast cancer patients, a meta-analysis was performed based on individual data of 18,203 participants from 16 randomized controlled trials starting before 2010. All trials included at least 6 cycles of chemotherapy in each arm. Three trials compared 6 courses of concurrent anthracycline/docetaxel/cyclophosphamide versus docetaxel/cyclophosphamide alone; 8 trials compared sequential anthracycline/taxane versus higher cumulative dose of docetaxel/cyclophosphamide; 3 trials compared anthracycline/taxane versus higher cumulative dose of taxane ± capecitabine, and 2 trials compared anthracycline/taxane versus higher cumulative dose of taxane plus carboplatin. Primary outcomes of the meta-analysis were recurrence and cause-specific mortality. Dr. Jeremy Baybrooke (University of Oxford, UK) presented the results [1]. Overall, patients treated with an anthracycline/taxane combination averaged 15% lower rates of breast cancer recurrence (RR 0.85; P=0.0003) than those receiving a taxane schedule without anthracycline, equating to an absolute reduction of 3.1% in 10-year recurrence (16.4% vs 19.0%). The 10-year risk of death from breast cancer was reduced by 1.6% (10.4% vs 12.0%; RR 0.87; P=0.02). The proportional reduction in recurrence was greatest in the 6 trials of concurrent anthracycline/docetaxel/cyclophosphamide versus docetaxel/cyclophosphamide alone (RR 0.58). By contrast, in trials of sequential anthracycline/taxane versus the higher cumulative dose of docetaxel/cyclophosphamide, there was no significant benefit from anthracycline (RR 0.92). Also regarding breast cancer mortality, concurrent anthracycline/taxane outperformed sequential anthracycline/taxane. There was a similar and highly significant proportional reduction in recurrence in ER-positive and in ER-negative disease and the RRs for recurrence did not differ significantly by any other pre-specified group including age, nodal status, tumor diameter, grade, and HER2 status. There were no significant increases in deaths without recurrence or death from cardiovascular disease or leukemia, though longer follow-up is needed to fully assess risks. Individual patient-level data on toxicity and/or quality of life were not available. “In conclusion, this meta-analysis demonstrates the addition of anthracycline to taxane chemotherapy, compared with taxane alone, reduced the risk of breast cancer recurrence by 15% with larger proportional reductions in trials of concurrent anthracycline compared with sequential anthracycline. In addition, the addition of anthracycline did not significantly increase death from cardiovascular disease or leukemia,” concluded Dr. Baybrooke.

  1. Baybrooke J, et al. Taxane with anthracycline versus taxane without anthracycline: An individual patient-level meta-analysis of 16,500 women with early-stage breast cancer in 13 randomized trials. SABCS 2021 Virtual Meeting, abstract GS2-06.

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