Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care Poster Display session

248P - Taxane & Cyclophosphamide vs Anthracycline & Taxane combination therapy as adjuvant treatment of breast cancer; a meta-analysis of randomized-controlled trials by the Hellenic Academy of Oncology (E.AK.O.)

Presentation Number
248P
Lecture Time
12:45 - 12:45
Speakers
  • Panagiotis Ntellas (Larissa, GR)
Location
Hall A3 - Poster Area Networking Hub, ICM M√ľnchen, Munich, Germany
Date
22.10.2018
Time
12:45 - 13:45

Abstract

Background

Adjuvant chemotherapy has an indisputable value for early breast cancer. Τaxane + cyclophosphamide combination (TC) has demonstrated superiority against cyclophosphamide + anthracycline (AC) in disease-free (DFS) and overall survival (OS). However, 5 randomized clinical trials (RCTs) failed to show non-inferiority of TC compared to an anthracycline-taxane combination (TaxAC). We conducted a meta-analysis of these RCTs to better estimate the cumulative evidence for non-inferiority of TC against TaxAC, in the adjuvant setting of HER2-negative, breast cancer.

Methods

The ABC trials, the Plan B trial and a trial by the Hellenic Oncology Research Group (HORG) were meta-analyzed. The DFS was the primary endpoint. A DFS-HR of 1.18 for TC versus TaxAC, was chosen to demonstrate inferiority, as it was the most conservative measure among the included studies. Secondary endpoints were OS and toxicity profile.

Results

Overall, 7,341 patients composed the meta-analysis population. We didn’t encounter heterogeneity between the trials (Q-test p = 0.55, I2:0%) and no publication bias was detected. Non-inferiority of TC was not established (DFS-HR=1.11, 95%CI: 0.95-1.30, p = 0.18). The combined DFS rates, according to the time points set by each study, were 89.04% versus 90.35% for TC and TaxAC respectively. Non-inferiority of TC was also not proven for the node-negative population either (HR = 1.05, 95%CI: 0.82-1.34, p = 0.71). Grade 3-4 leucopenia (OR: 1.2, 95%CI:1.068-1.348, p = 0.002) and thrombocytopenia (OR = 6.455; 95%CI:2.902-14.359, p < 0.001) prevailed in the TaxAC group, while cardiotoxicity was also increased (OR = 2.283; 95%CI:1.155-4.514, p = 0.015).

Conclusions

Although the TC combination was not proven to be non-inferior to TaxAC, the present analysis narrows the HR of recurrence risk of recurrence with a difference in the DFS rate of only 1,31%. Taking into account the more favorable safety profile of the TC combination, the question as to which treatment regimen should be preferred under what circumstances needs to be individualized according to patients’ characteristics and desires.

Legal entity responsible for the study

Hellenic Academy of Oncology.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

Collapse