A Cochrane review [Abstract] 1 included 29 studies involving a total of 41 911 women. Taxane-containing regimens improved overall survival (OS) and disease-free survival (DFS) compared to chemotherapy without a taxane (table T1). When a taxane-containing regimen was compared with the same regimen without a taxane, the beneficial effects of taxanes persisted for OS (HR 0.84, 95% CI 0.77 to 0.92; P < 0.001; 7 studies, n=10 842) and for DFS (HR 0.84, 95% CI 0.78 to 0.90; P < 0.001; 7 studies, n=10 842). Preliminary subgroup analysis by lymph node status showed a survival benefit with taxane-containing regimens in studies of women with lymph node-positive disease only (HR 0.83, 95% CI 0.78 to 0.88; P < 0.001; 17 studies, n=22 055) but less benefit in studies of women both with and without lymph node metastases or with no lymph node metastases. Taxane-containing regimens also improved DFS in women with lymph node-positive disease (HR 0.84, 95% CI 0.80 to 0.88; P < 0.001; 17 studies, n=22 055), although the benefit was marginal in studies of women both with and without lymph node-positive disease and was not apparent in studies of women with lymph node-negative disease. Taxanes resulted in a small increase in risk of febrile neutropenia and in a large increase in grade 3/4 neuropathy, but little or no difference in cardiotoxicity (table T1).
| Outcome | Relative effect(95% CI) | Risk with control - any chemotherapy without taxanes | Risk with intervention -taxane-containing chemotherapy (95% CI) | №of participants(studies)Quality of the evidence |
|---|---|---|---|---|
| Overall survival:Low baseline risk of death Follow-up: range 5 years to 10 years | HR 0.87(0.83 to 0.92) | 80 per 1000 | 70 per 1000(67 to 73) | 39 180(27) High |
| Overall survival:High baseline risk of death Follow-up: range 5 years to 10 years | 200 per 1000 | 176 per 1000(169 to 184) | ||
| Disease-free progression Low baseline risk of recurrenceFollow-up: range 4 years to 10 years | HR 0.88(0.85 to 0.92) | 140 per 1000 | 124 per 1000(120 to 130) | 41 909(29) High |
| Disease-free progression high baseline risk of recurrenceFollow-up: range 4 years to 10 years | 320 per 1000 | 288 per 1000(280 to 299) | ||
| Febrile neutropeniaFollow-up: 3 to 7 years | OR 1.43(0.89 to 2.31) | 56 per 1000 | 78 per 1000(50 to 120) | 34 154(23) Moderate |
| Neuropathy (including grade 3/4 sensory or motor neuropathy, or both)Follow-up: 3 to 7 years | OR 6.89 (3.23 to 14.71) | 6 per 1000 | 37 per 1,000(18 to 76) | 31 033(22) Moderate |
| Cardiotoxicity (including grade 3/4 and congestive cardiac failure)Follow-up: 3 to 10 years | OR 0.87(0.56 to 1.33) | 9 per 1000 | 8 per 1000(5 to 12) | 32 894(23) Moderate |
Primary/Secondary Keywords