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Selection of a Taxane As Well As Anthracycline for Early Breast Cancer

Cancer Care Centre, St George Hospital, Kogarah, New South Wales, Australia

To the Editor:

De Laurentiis et al¹ concluded that all subgroups in their meta-analysis benefited from adding a taxane to adjuvant anthracycline therapy for early breast cancer. This gives the impression that all anthracycline-treated patients will significantly benefit from having a taxane. The driving force behind the clinical benefit of adding a taxane demonstrated in the meta-analysis is the baseline high risk that the women in these trials faced, rather than whether they were HER-2–negative and or estrogen receptor–positive or in another subgroup. The major strength of a meta-analysis is the ability to determine a general conclusion as to overall efficacy of an intervention across many trials. The ability to generalize the conclusion from the meta-analysis to the clinical population remains constrained by the limits of the population entered into those trials. These women had an approximately 50% chance of relapse and 25% chance of death within 5 years. Many anthracycline-treated women have substantially lower baseline risks. Assuming a constant relative hazard ratio in these lower-risk women, the absolute benefit of adding a taxane will be commensurately lower than the incremental 5% disease-free survival and 3% overall survival benefit seen in the meta-analysis. Clinicians and patients should take this into account with provision of appropriate estimates of the absolute benefit when deciding on the costs and morbidities of additional taxane treatment.

AUTHOR'S DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The author(s) indicated no potential conflicts of interest.

REFERENCE

1. De Laurentiis M, Cancello G, D'Agostino D, et al: Taxane-based combinations as adjuvant chemotherapy of early breast cancer: A meta-analysis of randomized trials. J Clin Oncol 26:44-53, 2008[Abstract/Free Full Text]

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• In Reply
  Michele De Laurentiis and Sabino De Placido
  JCO 2008 26: 2417 [Full Text]

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