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
ARTICLE HIGHLIGHTS
Research background

There are mainly two active group of chemotherapy regimen namely Anthracyclines and taxanes. Randomized controlled trials (RCTs) have reported variable evidences regarding efficacy of taxanes over anthracyclines especially for tumor response and survival outcomes. Hence, as required, the present study synthesizes the relative efficacy of taxanes over anthracyclines using pathological complete response, clinical responses, breast-conserving surgeries and survival outcomes in female breast cancer patients by systematic review and meta-analysis of available RCTs.

Research motivation

There is contradictory reporting regarding relative efficacy of taxanes over anthracycline. To resolve this, for the first time, present meta-analysis is to assess the relative efficacy of taxanes (Docetaxel and Paclitaxel) alone or their addition to anthracyclines over anthracyclines alone in terms of pCR, clinical response, breast conserving surgery, survival outcomes and toxicity in neo-adjuvant setting. As and when there is further addition in regimes, such appraisals from time to time are unavoidable.

Research objectives

Keeping in view of contradictory reporting, this study aimed to assess the relative effectiveness of taxanes over anthracyclines in neo-adjuvant setting in terms of tumor response and survival outcomes through systematic review and Meta analysis. This was expected to provide important clues regarding appropriate clinical practice.

Research methods

The RCTs have reported contradictory findings on relative effectiveness of taxanes over anthracyclines in neo-adjuvant setting regarding treatment of breast cancer patients. In spite of this, no earlier attempt is made to synthesize relative effectiveness of taxanes over anthracyclines. For the first time, using a focused systematic review and Meta analysis of existing RCTs, this study attempted to synthesize relative effectiveness of taxanes over anthracyclines in terms of pCR, clinical response, BCS, survival outcomes and toxicity in neo-adjuvant setting. For this, all related RCTs were searched through PubMed and Cochrane register of controlled trials on 28 April 2017 and published in English language. Using PRISMA guidelines, retrieved records were screened and data were extracted by two independent reviewers. Depending on heterogeneity assessed through I2 statistic, Meta-analysis was performed using either fixed effect or random effect method. Subgroup meta-analyses were also performed for each considered outcomes on the basis of taxanes alone or taxanes along with anthracyclines in comparison to anthracyclines alone.

Research results

Through a search through PubMed and Cochrane register of controlled trials on 28 April 2017, for this study, a total of 16 RCTs were found eligible in view of reporting at least one of the considered outcomes. The analytical results revealed that taxanes based chemotherapy significantly improved pCR, disease free survival and loco-regional recurrence free survival. Further, subgroup analysis showed that addition of taxanes to anthracyclines has better effectiveness regarding these survivals over anthracyclines alone than taxanes alone over anthracyclines alone.

Research conclusions

This study hypothesized that effectiveness of neo-adjuvant chemotherapy may rely on used regimens. Keeping in view of varying reporting under related RCTs, as an appraisal, to assess relative effectiveness of taxanes in comparison to anthracyclines was planned. For this, it was carried out as a first systematic review and Meta analysis of the related RCTS. As obvious, as a first-time observation, the synthesized results suggest that taxanes based chemotherapy may significantly improve pCR, disease free survival and loco-regional recurrence free survival. Further, as additional clues, subgroup analysis showed that addition of Taxanes to anthracyclines emerged to be more effective regarding these survivals over anthracyclines alone than taxanes alone over anthracyclines alone.

Research perspectives

In presence of contradictory findings under RCTs, a systematic review and Meta analysis of available RCTs may provide important clues towards clinical practice. Completeness of data is crucial for such studies. To achieve this, as true in case of other study designs, an appropriate protocol needs to be written for carrying out such studies. Although such studies are being carried out on other study designs as well, to ensure high level of evidence, such studies on RCTs need to be preferred.