Influence of control group therapy on the benefit from dose-dense chemotherapy in early breast cancer: a systemic review and meta-analysis.

Autor: Goldvaser H; Division of Medical Oncology, Princess Margaret Cancer Centre and the University of Toronto, 610 University Ave, Toronto, ON, M5G 2M9, Canada.; Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel., Majeed H; Division of Medical Oncology, Princess Margaret Cancer Centre and the University of Toronto, 610 University Ave, Toronto, ON, M5G 2M9, Canada., Ribnikar D; Division of Medical Oncology, Princess Margaret Cancer Centre and the University of Toronto, 610 University Ave, Toronto, ON, M5G 2M9, Canada., Šeruga B; Department of Medical Oncology, Institute of Oncology Ljubljana, 2 Zaloska cesta, 1000, Ljubljana, Slovenia., Ocaña A; Translational Research Unit, Albacete University Hospital and CIBERONC, calle Francisco Javier de Moya, 02006, Albacete, Spain., Cescon DW; Division of Medical Oncology, Princess Margaret Cancer Centre and the University of Toronto, 610 University Ave, Toronto, ON, M5G 2M9, Canada., Amir E; Division of Medical Oncology, Princess Margaret Cancer Centre and the University of Toronto, 610 University Ave, Toronto, ON, M5G 2M9, Canada. eitan.amir@uhn.ca.
Jazyk: angličtina
Zdroj: Breast cancer research and treatment [Breast Cancer Res Treat] 2018 Jun; Vol. 169 (3), pp. 413-425. Date of Electronic Publication: 2018 Feb 08.
DOI: 10.1007/s10549-018-4710-5
Abstrakt: Purpose: Results from clinical trials of adjuvant dose-dense chemotherapy in patients with breast cancer are inconsistent.
Methods: A systematic search of MEDLINE identified studies comparing the efficacy of dose-dense adjuvant chemotherapy to a standard treatment. The primary analysis included studies that used identical regimens in the experimental and control groups, but varied only dose density. A secondary analysis included studies that used either different drugs or doses in the experimental and the control groups. Hazard ratios (HRs) and 95% confidence intervals were computed for disease-free survival (DFS) and overall survival (OS) and pooled in a meta-analysis. Subgroup analyses and meta-regression explored drug schedules utilized in control groups and the influence of clinicopathologic variables on benefit from dose-dense therapy.
Results: The primary analysis included 5 studies comprising 9819 patients while the secondary analysis included 6 studies comprising 9679 patients. Dose-dense treatment significantly improved DFS (HR 0.85, p < 0.001) and OS (HR 0.86, p = 0.008) in the primary analysis. Similar results were observed in the secondary analysis. Dose-dense schedule was important primarily in studies utilizing paclitaxel every 3 weeks as the control group (interaction p = 0.04 for DFS interaction p = 0.001 for OS). A significantly greater relative magnitude of benefit was observed in pre-menopausal women and those with nodal involvement, but there was no influence of hormone receptor status on results.
Conclusions: Adjuvant dose-dense regimens improve breast cancer outcomes. It remains uncertain whether the observed benefit reflects the impact of dose density or the inferiority of paclitaxel every 3 weeks as a control group.
Databáze: MEDLINE
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