The Pharmaceutical Journal
Vol 268 No 7199 p705-712
25 May 2002

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Taxanes of benefit in breast cancer

Replacing 5-fluorouracil with doce-taxel (Taxotere) in adjuvant combination chemotherapy improves survival and reduces breast cancer recurrence.

Professor Jean-Marc Nabholtz, University of California at Los Angeles and chairman of the Breast Cancer International Research Group, and colleagues conducted a study in 1,491 women with early-stage breast cancer. Half were randomised to receive docetaxel and half 5-fluorouracil, both given in combination with doxorubicin and cyclophosphamide.

After three years, 82 per cent of patients on the docetaxel regimen were disease free compared with 74 per cent on the 5-fluorouracil regimen. This represents a 32 per cent risk reduction for disease recurrence (P=0.0011). The most significant benefit of docetaxel was seen in patients with one to three positive lymph nodes. Among these women, docetaxel reduced the risk of relapse by 50 per cent and the mortality rate by 54 per cent. The improvements occurred regardless of hormone receptor status.

The docetaxel regimen was associated with higher levels of febrile neutropenia, occurring in 24 per cent of patients compared with 2 per cent of the 5-fluorouracil group. The study was sponsored by Aventis.

A second study, sponsored by Bristol-Myers Squibb, showed that adding paclitaxel (Taxol) to primary systemic therapy before surgery can reduce the likelihood of needing a mastectomy. Preliminary results from 983 patients in the ECTO (European Co-operative trial in operable breast cancer) study showed that adding paclitaxel to standard therapy allowed 68 per cent of women to have more conservative breast surgery compared with 34 per cent in the standard therapy group. Standard therapy was doxorubicin followed by cyclophosphamide, methotrexate and 5-fluorouracil.