Lang Istvan, Rubovszky Gabor, Horvath Zsolt, Ganofszky Erna, Szabo Eszter, Dank Magdolna, Boer Katalin, Hitre Erika
National Institute of Oncology , Budapest .
J Clin Diagn Res. 2013 Jun;7(6):1120-4. doi: 10.7860/JCDR/2013/4742.3027. Epub 2013 Jun 1.
Among the presently available cytotoxic drugs, paclitaxel, in combination with doxorubicin and carboplatin, come under the highly active therapy for metastatic breast cancer. Between the two brands of paclitaxel (Intaxel, which is marketed by Fresenius Kabi and Taxol, the original paclitaxel which is manufactured by BMS) the similarity has not been evaluated in clinical trial settings till date. This prospective, controlled, randomized, multicentre, open-label phase IV study was planned to compare the safety and efficacy of Intaxel with Taxol, when they were used in combination with carboplatin or doxorubicin, as a second line treatment for metastatic breast cancer.
Fourty nine eligible patients were randomized to receive Intaxel or Taxol with either doxorubicin or carboplatin. The patients who had received a prior anthracycline based chemotherapy were randomized to the paclitaxel/carboplatin arm. The patients were evaluated in three phases i.e. at baseline, during the treatment and at follow up for the tumour response, the time period till the disease progression and the toxicity. The time till the disease progression was assessed by the Kaplan-Meier method. The continuous and categorical variables were assessed by using the ANOVA test and Fisher's exact test, respectively.
After 3 cycles, an objective response rate of 55.56% (CR = 3, PR = 7) was noted in the Intaxel group and that of 59.09% (CR = 1, PR = 12) was noted in the Taxol group. After 6 cycles, an objective response rate of 50% was noted in both the groups. No significant difference was observed in the response rate of the two groups after 3 cycles (p > 0.05) and at the end of the treatment (p > 0.05). The patients who received Intaxel had a lower incidence of thrombocytopaenia (p = 0.0146) and neurosensory loss (p = 0.008) as compared to those who received Taxol.
The results of this study demonstrated that the safety and efficacy of Intaxel and Taxol are equivalent when they are used in combination with other cytotoxic agents as the second line of treatment for metastatic stage IV breast cancer.
在目前可用的细胞毒性药物中,紫杉醇与阿霉素和卡铂联合使用,属于转移性乳腺癌的高活性治疗方法。在两种品牌的紫杉醇(由费森尤斯卡比公司销售的安素泰以及由百时美施贵宝公司生产的原始紫杉醇泰素)之间,迄今为止尚未在临床试验环境中评估它们的相似性。这项前瞻性、对照、随机、多中心、开放标签的IV期研究旨在比较安素泰与泰素在与卡铂或阿霉素联合使用时作为转移性乳腺癌二线治疗的安全性和有效性。
49名符合条件的患者被随机分配接受安素泰或泰素,并联合阿霉素或卡铂。之前接受过基于蒽环类药物化疗的患者被随机分配到紫杉醇/卡铂组。对患者进行三个阶段的评估,即基线期、治疗期间和随访期,以评估肿瘤反应、疾病进展时间和毒性。疾病进展时间采用Kaplan-Meier方法评估。连续变量和分类变量分别采用方差分析和Fisher精确检验进行评估。
3个周期后,安素泰组的客观缓解率为55.56%(完全缓解=3例,部分缓解=7例),泰素组为59.09%(完全缓解=1例,部分缓解=12例)。6个周期后,两组的客观缓解率均为50%。两组在3个周期后(p>0.05)和治疗结束时(p>0.05)的缓解率无显著差异。与接受泰素的患者相比,接受安素泰的患者血小板减少症(p=0.0146)和神经感觉丧失(p=0.008)的发生率较低。
本研究结果表明,安素泰和泰素在与其他细胞毒性药物联合用作转移性IV期乳腺癌的二线治疗时,其安全性和有效性相当。