Meta-Analysis
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Apr 30, 2019; 7(4): 170-183
Published online Apr 30, 2019. doi: 10.13105/wjma.v7.i4.170
Effectiveness of taxanes over anthracyclines in neoadjuvant setting: A systematic-review and meta-analysis
Mona Pathak, Sada Nand Dwivedi, SVS Deo, Bhaskar Thakur, Vishnubhatla Sreenivas, Goura Kishor Rath
Mona Pathak, Sada Nand Dwivedi, Vishnubhatla Sreenivas, Department of Biostatistics, All India Institute of Medical Sciences, New Delhi 110029, India
Mona Pathak, Bhaskar Thakur, Division of Biostatistics, Kalinga Institute of Medical Sciences, Bhubaneswar 751024, India
SVS Deo, Department of Surgical Oncology, BRAIRCH, All India Institute of Medical Sciences, New Delhi 110029, India
Goura Kishor Rath, Department of Radiotherapy, BRAIRCH, All India Institute of Medical Sciences, New Delhi 110029, India
Author contributions: Pathak M, Dwivedi SN, Deo SVS and Sreenivas V conceived and designed the study. Study searching was done by Pathak M. Further, Studies screening and selection was done by Pathak M and Thakur B independently and disagreement was resolved by Deo SVS. Pathak M and Thakur B performed data extraction independently. Pathak M did analysis in supervision of Dwivedi SN. All authors were involved in interpretation of the results. The final draft of this manuscript was done by Pathak M and read and approved by all the authors.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The manuscript is designed as per PRISMA 2009 guideline and checklist is provided as supplementary file.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Sada Nand Dwivedi, PhD, Professor, Department of Biostatistics, All India Institute of Medical Sciences, Room No.5, New Delhi 110029, India. dwivedi@aiims.ac.in
Telephone: +91-11-26593387
Received: March 2, 2019
Peer-review started: March 4, 2019
First decision: April 11, 2019
Revised: April 20, 2019
Accepted: April 23, 2019
Article in press: April 23, 2019
Published online: April 30, 2019
Processing time: 60 Days and 15.5 Hours
Abstract
BACKGROUND

Anthracyclines and taxanes are more active group of chemotherapy regimen. Randomized controlled trials (RCTs) reported variable evidences regarding efficacy of taxanes over anthracyclines for tumor response and survival outcomes. The present study compares the relative efficacy of taxanes over anthracyclines using pathological complete response (pCR), clinical responses, breast-conserving surgeries and survival outcomes in female breast cancer patients by systematic review and meta-analysis of available RCTs.

AIM

To assess the effectiveness of taxanes over anthracyclines in neoadjuvant setting in terms of tumor response and survival outcomes.

METHODS

All RCTs assessing efficacy of taxanes over anthracyclines in neoadjuvant setting for management of breast cancer searched through PubMed and Cochrane register of controlled trials on 28 April 2017 and published in English language were considered. Following PRISMA guideline, retrieved records were screened and data were extracted by two independent reviewers. Meta-analysis was performed using fixed effect or random effect method depending on heterogeneity assessed using I2 statistic. Subgroup meta-analyses on the basis of taxane alone or taxane along with anthracycline in comparison to anthracycline alone were also performed for each considered outcomes.

RESULTS

A total of 16 RCTs involving 6752 breast cancer patients were found eligible. Taxanes based chemotherapy significantly improved pCR (n = 7, RR = 1.48, 95%CI: 1.04-2.12), disease free survival [n = 6, RR = 0.89 (0.80-0.99)] and loco-regional recurrence free survival [n = 4, RR = 0.74 (0.59-0.94)]. Interestingly in subgroup analysis, addition of taxane to anthracyclines showed better effectiveness regarding these survivals over anthracyclines than taxane alone over anthracycline.

CONCLUSION

Addition of taxanes to anthracyclines based chemotherapy significantly improves pCR, disease free survival and loco-regional recurrence free survival but with no significant impact on breast conservation rates.

Keywords: Docetaxel, Paclitaxel, Epirubicin, Doxorubicin, Pathological complete response, Breast conserving surgery

Core tip: There is contradictory reporting through randomized controlled trials regarding relative efficacy of taxanes over anthracyclines which are used in neo-adjuvant setting for treatment of breast cancer patients. As a first systematic review and Meta analysis on the topic, present study is to assess the relative efficacy of taxanes (docetaxel and paclitaxel) alone or their addition to anthracyclines over anthracyclines alone in terms of pathological complete response, clinical response, breast conserving surgery, survival outcomes and toxicity.