Department of Medical Oncology, General Hospital of Lamia, Greece.
Cancer Treat Rev. 2010 Feb;36(1):69-74. doi: 10.1016/j.ctrv.2009.10.006. Epub 2009 Nov 27.
Taxanes have been extensively tested in patients with advanced breast cancer, but it is unclear whether their weekly use might offer any benefits against standard every three weeks administration. We therefore performed a meta-analysis of randomized controlled trials that compared weekly and every three weeks taxanes regimens in advanced breast cancer.
The endpoints that we assessed were objective response rate, progression free survival (PFS) and overall survival. Efficacy data for paclitaxel and docetaxel were separately analyzed. Trials were located through PubMed and Cochrane Library searches and abstracts of major international conferences.
Omicronbjective response rate was notably better when paclitaxel was used as every three weeks regimen (7 studies, 1772 patients, fixed effect model pooled RR 1.20 95%CI 1.08-1.32 p<0.001). No difference were found for PFS (6 studies, 1610 patients, random effect model HR 1.02, 95%CI 0.81-1.30 p=0.860); while OS was statistically higher among patients receiving weekly paclitaxel (5 studies, 1471 patients, fixed effect model pooled HR 0.78, 95%CI 0.67-0.89 p=0.001). No differences were observed for the weekly compared to the every three weeks use of docetaxel either for objective response, PFS and OS. Overall, the incidence of serious adverse events, neutropenia, neutropenic fever, and peripheral neuropathy were significantly lower in weekly taxanes schedules. The incidence of nail changes and epiphora were significantly lower in the every three weeks docetaxel regimens.
Use of paclitaxel in weekly regimen give overall survival advantages compared with the standard every three weeks regimen. The observed survival benefit does not seem to stem from an increased potency of the drug with weekly regimens. The use of weekly paclitaxel regimens is therefore recommended for the treatment of locally advanced/metastatic breast cancer.
紫杉烷类药物已在晚期乳腺癌患者中广泛应用，但目前尚不清楚每周使用是否比标准的每 3 周方案更有优势。因此，我们进行了一项荟萃分析，比较了晚期乳腺癌中每周和每 3 周使用紫杉烷类药物的方案。
我们评估的终点是客观缓解率、无进展生存期（PFS）和总生存期。分别分析了紫杉醇和多西他赛的疗效数据。通过 PubMed 和 Cochrane 图书馆检索以及主要国际会议摘要查找试验。
紫杉醇作为每 3 周方案时，客观缓解率显著提高（7 项研究，1772 例患者，固定效应模型汇总 RR 1.20，95%CI 1.08-1.32，p<0.001）。无进展生存期无差异（6 项研究，1610 例患者，随机效应模型 HR 1.02，95%CI 0.81-1.30，p=0.860）；而每周紫杉醇组患者的总生存期统计学上更高（5 项研究，1471 例患者，固定效应模型汇总 HR 0.78，95%CI 0.67-0.89，p=0.001）。与每 3 周使用多西他赛相比，每周使用多西他赛在客观缓解、PFS 和 OS 方面均无差异。总体而言，每周紫杉醇方案的严重不良事件、中性粒细胞减少症、中性粒细胞减少症发热和周围神经病变发生率显著降低。每 3 周多西他赛方案的指甲改变和溢泪发生率显著降低。
与标准的每 3 周方案相比，每周紫杉醇方案可带来总生存优势。观察到的生存获益似乎并非源于每周方案增加了药物的效力。因此，建议将每周紫杉醇方案用于治疗局部晚期/转移性乳腺癌。
