Taxanes in the Adjuvant Treatment of Early Breast Cancer, Emerging Consensus and Unanswered Questions

Abstract

Anthracyclines were standard chemotherapy agents in the adjuvant treatment of early breast cancer. Taxanes are newer tubulin-targeting agents that have little cross-resistance and limited overlapping toxicities with anthracyclines. In the past decade, large number of randomized phase-III clinical trials has been conducted worldwide to determine if the addition of taxanes to anthracyclines would improve the disease-free or overall survival of patients with early breast cancer. Many of these first-generation taxane trials are now mature with available survival data. Pooled analyses from these trials consistently demonstrated survival advantage when taxanes were added to anthracyclines or nonanthracycline regimen. The second-generation taxane trials are focusing on how to optimally combine taxanes with the anthracyclines, sequentially, or concurrently, dosing and frequency of administration, duration of therapy and measures to reduce the taxane toxicity. The future direction of clinical research on taxanes or third-generation taxane trials involves identification of predictive markers for response to taxanes, application of novel taxanes and combination of taxanes to other biological agents in order to offer taxanes to selected patients with early breast cancer to increase the efficacy and minimize the toxicity. While many of the second-generation taxane trials are still ongoing, the choice of specific taxane regimen should be based on evidence from the published clinical trials and tailoring to the particular needs of individual patient.

Keywords:

• Taxanes
• Docetaxel
• Paclitaxel
• Anthracyclines
• Clinical trials
• Early breast cancer
• Disease-free and overall survival
• Meta-analysis
• Sequencing
• Dosage
• Scheduling and safety