The Clinical Efficacy and Safety of Paclitaxel in Adjuvant Therapy of Breast Cancer: A Systematic Review and Meta-Analysis
Keywords:Paclitaxel, Breast cancer, efficacy, adverse reactions, systematically review, Meta-analysis, randomized controlled trial.
Purpose: To systematically review the clinical efficacy and adverse reactions of Paclitaxel for the treatment of mammary cancer.
Math: We searched Web of knowledge, PubMed, VIP information and CNKI (to October 2013) on randomised controlled trial about Paclitaxel for the treatment of mammary cancer and retrieved relevant reference and research material by hand. Two authors independently screened document, extracted data and assessed the quality according to inclusion and exclusion criteria, we finally used the software RevMan 5.2 from Cochrane for Meta-analysis.
Result: 18 randomized controlled clinical study were brought into our study according to inclusion and exclusion criteria, including 10712 patients. The result of meta-analysis showed that the odds ratios of Paclitaxel for adjunctive therapy [OR = 1.64, 95% CI (1.40, 1.92), P <0.00001] was better than conventional drugs, while the overall survival was no significant difference between Paclitaxel and conventional drugs. The further Subgroup analysis showed that the efficacy of Paclitaxel for adjunctive therapy was better than cyclophosphamide [OR = 1.41, 95%C I (1. 07, 1.85), P =0. 01] and NVB [OR = 2.10, 95% CI (1.33, 3.30), P =0.001]. The adverse reactions analysis results showed the ratio of myelosuppression and alopecia by treated with Paclitaxel was improved, while the occurrence of gastrointestinal reaction rate was decreased.
Conclusion: The current evidence showed Paclitaxel was effective for the adjuvant treatment of breast cancer, but the above conclusions still need future expansion of more samples, high quality RCT verify.Keyword: Paclitaxel, Breast cancer, efficacy, adverse reactions, systematically review, Meta-analysis, randomized controlled trial.
Qiongying F, Qiong W, Xiuling Z. Analysis of the prevalence of the Breast Cancer [J]. Chin J Soc Med 2012; 29(25): 333.
Yonggang X, Yong M, Jiahong L. Evaluation of the New Rural Cooperative Medical System in Relieving the Disease Burden on Farmers in One City [J] Chin Health Quality Manag 2009; 16(2): 2-5.
AD S, A T, C H. Phase trial of paclitaxel by 3-hour infusion as initial and salvage chemotherapy for metastatic breast cancer [J]. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology 1995; 13(10) 2575-2581.
Junli L. Clinical observation of TP and NP regimen in patients with advanced breast cancer [J]. Chin J Mod Med 2007; 17(19): 2405-2407.
Fuxi H, Xiaolong C. Clinical observation of TP and NP regimen in the treatment of advanced breast cancer [J]. Chin Med Herald 2008; 5(36): 41-42.
Ximei H, Bingguang S, Huakun L, et al. The comparison of TP and NP regimens in the treatmentof advanced breast cancer [J]. Mod Oncol 2007; 15(11): 1603-1605.
Shenxiang F, Ming D, Wei G, et al. The clinical observation of combined chemotherapy for advanced breast cancer [J]. Mod Oncol 2005; 13(5): 654-655.
Xinbin H, Longxing Z, Shengyuan L. The clinical observation of taxol plus cisplatin versus gemcitabine plus cisplatin as a treatment of advanced metastatic breast cancer [J]. Med J GEHQ 2010; 12(2): 99-101.
Lang I, Brodowicz T, Ryvo L, et al. Bevacizumab plus paclitaxel versus bevacizumab plus capecitabine as first-line treatment for HER2-negative metastatic breast cancer: interim efficacy results of the randomised, open-label, non-inferiority, phase 3 TURANDOT trial [J]. Lancet Oncol 2013; 14(2): 125-133. http://dx.doi.org/10.1016/S1470-2045(12)70566-1
Buzdar AU, Singletary SE, Valero V, et al. Evaluation of paclitaxel in adjuvant chemotherapy for patients with operable breast cancer Preliminary data of a prospective randomized trial [J]. Clin Cancer Res 2002; 8: 1073-1079.
Lyman GH, Green SJ, Ravdin PM, et al. A Southwest Oncology Group randomized phase II study of doxorubicin and paclitaxel as frontline chemotherapy for women with metastatic breast cancer [J]. Breast Cancer Res Treat 2004; 85: 143-150. http://dx.doi.org/10.1023/B:BREA.0000025405.63953.f9
Xu B, Jiang Z, Kim SB, et al. Biweekly gemcitabine-paclitaxel, gemcitabine-carboplatin, or gemcitabine-cisplatin as first-line treatment in metastatic breast cancer after anthracycline failure: a phase II randomized selection trial [J]. Breast Cancer 2011; 18(3): 203-212. http://dx.doi.org/10.1007/s12282-011-0260-y
Martin M, Rodriguez-Lescure A, Ruiz A, et al. Molecular predictors of efficacy of adjuvant weekly paclitaxel in early breast cancer [J]. Breast Cancer Res Treat 2010; 123(1): 149-157. http://dx.doi.org/10.1007/s10549-009-0663-z
Langley RE, Carmichael J, Jones AL, et al. Phase III trial of epirubicin plus paclitaxel compared with epirubicin plus cyclophosphamide as first-line chemotherapy for metastatic breast cancer: United Kingdom National Cancer Research Institute trial AB01 [J]. Journal of Clinical Oncology: official journal of the American Society of Clinical Oncology 2005; 23(33): 8322-8330. http://dx.doi.org/10.1200/JCO.2005.01.1817
Lang I, Inbar MJ, Kahan Z, et al. Safety results from a phase III study (TURANDOT trial by CECOG) of first-line bevacizumab in combination with capecitabine or paclitaxel for HER-2-negative locally recurrent or metastatic breast cancer [J]. Eur J Cancer 2012; 48(17): 3140-3149. http://dx.doi.org/10.1016/j.ejca.2012.04.022
Martin M, Rodriguez-Lescure A, Ruiz A, et al. Randomized phase 3 trial of fluorouracil, epirubicin, and cyclophosphamide alone or followed by Paclitaxel for early breast cancer [J]. J Natl Cancer Instit 2008; 100(11): 805-814. http://dx.doi.org/10.1093/jnci/djn151
Mamounas EP, Bryant J, Lembersky B, et al. Paclitaxel after doxorubicin plus cyclophosphamide as adjuvant chemotherapy for node-positive breast cancer: results from NSABP B-28 [J]. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology 2005; 23(16): 3686-3696. http://dx.doi.org/10.1200/JCO.2005.10.517
Jassem J, Pien´kowski T, P?u°zan´ska A, et al. Doxorubicin and paclitaxel versus fluorouracil, doxorubicin, and cyclophosphamide as first-line therapy for women with metastatic breast cancer final results of a randomized phase III multicenter trial [J]. J Clin Oncol 2001; 19(6): 1707-1715.
Sledge GW. Phase III Trial of Doxorubicin, Paclitaxel, and the Combination of Doxorubicin and Paclitaxel as Front-Line Chemotherapy for Metastatic Breast Cancer: An Intergroup Trial (E1193) [J]. J Clin Oncol 2003; 21(4): 588-592. http://dx.doi.org/10.1200/JCO.2003.08.013
Buzdar AU, Singletary SE, Theriault RL, et al. Prospective evaluation of paclitaxel versus combination chemotherapy with fluorouracil, doxorubicin, and cyclophosphamide as neoadjuvant therapy in patients with operable breast cancer [J]. J Clin Oncol 1999; 17(11): 3412-3417.
Gianni L, Baselga J, Eiermann W, et al. Feasibility and tolerability of sequential doxorubicin/paclitaxel followed by cyclophosphamide, methotrexate, and fluorouracil and its effects on tumor response as preoperative therapy [J]. Clinical Cancer Research: an Official Journal of the American Association for Cancer Research 2005; 11(24 Pt 1): 8715-8721.
Deying K, Qi H, Guanjian L, et al. Investigating and dealing with publication bias in Meta analysis [J]. Chin J Evidence Based Med 2003; 3(1): 45-49.