Article

Weekly Paclitaxel in the Adjuvant Treatment of Breast Cancer

Eastern Cooperative Oncology Group, Philadelphia, USA.
New England Journal of Medicine (Impact Factor: 54.42). 04/2008; 358(16):1663-71. DOI: 10.1056/NEJMoa0707056
Source: PubMed

ABSTRACT We compared the efficacy of two different taxanes, docetaxel and paclitaxel, given either weekly or every 3 weeks, in the adjuvant treatment of breast cancer.
We enrolled 4950 women with axillary lymph node-positive or high-risk, lymph node-negative breast cancer. After randomization, all patients first received 4 cycles of intravenous doxorubicin and cyclophosphamide at 3-week intervals and were then assigned to intravenous paclitaxel or docetaxel given at 3-week intervals for 4 cycles or at 1-week intervals for 12 cycles. The primary end point was disease-free survival.
As compared with patients receiving standard therapy (paclitaxel every 3 weeks), the odds ratio for disease-free survival was 1.27 among those receiving weekly paclitaxel (P=0.006), 1.23 among those receiving docetaxel every 3 weeks (P=0.02), and 1.09 among those receiving weekly docetaxel (P=0.29) (with an odds ratio >1 favoring the groups receiving experimental therapy). As compared with standard therapy, weekly paclitaxel was also associated with improved survival (odds ratio, 1.32; P=0.01). An exploratory analysis of a subgroup of patients whose tumors expressed no human epidermal growth factor receptor type 2 protein found similar improvements in disease-free and overall survival with weekly paclitaxel treatment, regardless of hormone-receptor expression. Grade 2, 3, or 4 neuropathy was more frequent with weekly paclitaxel than with paclitaxel every 3 weeks (27% vs. 20%).
Weekly paclitaxel after standard adjuvant chemotherapy with doxorubicin and cyclophosphamide improves disease-free and overall survival in women with breast cancer. (ClinicalTrials.gov number, NCT00004125 [ClinicalTrials.gov].).

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    • "They concluded that the group receiving weekly paclitaxel had significantly more moderate-to-severe neuropathy than the group receiving standard therapy which was consistent with our results. Moreover, the group receiving docetaxel every 3 weeks showed significantly more severe neutropenia and its associated complications which were more frequent in docetaxel group than paclitaxel [5]. Ishikawa and colleagues evaluated the feasibility of AC/EC every three weeks followed by weekly paclitaxel or four cycles of three consecutive weekly administration followed by a one-week rest (3 × 4) and reported during AC/EC, (68%) of patients developed grade 3/4 granulocytopenia, compared to (7.8%) receiving 12 PAC and (2.1%) receiving 3 × 4 PAC. "
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