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Revisión sistemática

No clasificado

Autores Chen W , Tu Q , Shen Y , Tang K , Hong M , Shen Y
Revista World journal of surgical oncology
Año 2021
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BACKGROUND: Whether a sequential or concurrent regimen of anthracyclines and taxanes is superior for breast cancer is controversial. We compared the efficacy of two regimens in patients with operable breast cancer based on all relevant published data of phase III randomized controlled trials. METHODS: A comprehensive literature search on PubMed, Web of Science, Embase, ScienceDirect, Google Scholar, and ClinicalTrials.gov databases was performed up to May 2020. Meta-analysis was performed to evaluate the different efficacy on disease-free survival (DFS) and overall survival (OS) for the two chemotherapy regimens. Subgroup analyses were further carried out in terms of node status and anthracycline selection. RESULTS: Compared to the concurrent regimen, the sequential regimen did not improve the DFS or OS in the population studied. Subgroup analysis showed that in node-positive patients, the sequential regimen had better DFS, but not OS, than the concurrent regimen. In sequential regimen, patients who received doxorubicin and taxanes had improved DFS and OS than patients who were administered epirubicin and taxanes. Furthermore, for patients who received doxorubicin and taxanes, compared to the sequential regimen, fewer cycles (4 cycles) of concurrent treatment resulted in a worse DFS and OS, which can be rescued by more cycles (6 cycles). CONCLUSIONS: The sequential regimen of anthracyclines and taxanes for patients with operable breast cancer did not yield a significant benefit in DFS or OS over the concurrent regimen. The sequential regimen, however, provided a better DFS than concurrent regimen for node-positive patients. Interestingly, further subgroup analysis showed that for node-positive patients who were given doxorubicin and taxanes, more cycles (6 cycles) of the concurrent regimen may rescue the efficacy for fewer cycles (4 cycles).

Revisión sistemática

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Autores Jiang M , Chen W , Hu Y , Chen C , Li H
Revista Medicine
Año 2021
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BACKGROUND: Ovarian function suppressor (OFS) plus either tamoxifen (TAM) or aromatase inhibitor (AI) could improve the survival outcome for premenopausal hormone receptor-positive (HR+) breast cancer. However, the optimal OFS-based regimen and medication duration remain uncertain. This article aims to systematically evaluate the OFS-based adjuvant endocrine therapy for premenopausal breast cancer. METHODS: We searched several public databases from January 1980 to November 2020. A random model was adopted in this meta-analysis. We used the hazard ratio (HR) with a 95% confidence interval (CI) for the statistical analysis of efficacy. The primary outcome measures included overall survival and disease-free survival. RESULTS: A total of 32 articles with 37,224 cases were included in this network meta-analysis. OFS+TAM improved 5-year disease-free survival (HR -0.09, 95% CI -0.16 to -0.01) and 5-year overall survival (HR -0.18, 95% CI -0.33 to -0.03) compared with TAM monotherapy. For OFS+AI, although the 5-year disease-free survival was improved (HR -0.18, 95% CI -0.29 to -0.08), the 5-year overall survival was not improved (HR -0.13, 95% CI -0.43 to 0.18). In subgroup analysis, both OFS+AI and OFS+TAM showed a protective effect in stage I-III patients compared with stage I-II patients. For the course of therapy, OFS+TAM for 2-years could achieve clinical benefit and the best course of therapy of OFS+AI still waits for further study. CONCLUSIONS: OFS+TAM might be a better option than OFS+AI for premenopausal intensive adjuvant endocrine therapy. Stage III patients are more suitable for the OFS-based therapy. For the medication duration, the 2-years course of OFS+TAM could be effective. This analysis provides helpful information for selecting therapeutic regimen in intensive adjuvant endocrine therapy and identifying the target population.

Revisión sistemática

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Revista The Cochrane database of systematic reviews
Año 2019
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BACKGROUND: Adjuvant chemotherapy improves survival in premenopausal and postmenopausal women with early breast cancer. Taxanes are highly active chemotherapy agents used in metastatic breast cancer. Review authors examined their role in early breast cancer. This review is an update of a Cochrane Review first published in 2007. OBJECTIVES: To assess the effects of taxane-containing adjuvant chemotherapy regimens for treatment of women with operable early breast cancer. SEARCH METHODS: For this review update, we searched the Specialised Register of the Cochrane Breast Cancer Group, MEDLINE, Embase, CENTRAL (2018, Issue 6), the WHO International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov on 16 July 2018, using key words such as 'early breast cancer' and 'taxanes'. We screened reference lists of other related literature reviews and articles, contacted trial authors, and applied no language restrictions. SELECTION CRITERIA: Randomised trials comparing taxane-containing regimens versus non-taxane-containing regimens in women with operable breast cancer were included. Studies of women receiving neoadjuvant chemotherapy were excluded. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias and quality of the evidence using the GRADE approach. Hazard ratios (HRs) were derived for time-to-event outcomes, and meta-analysis was performed using a fixed-effect model. The primary outcome measure was overall survival (OS); disease-free survival (DFS) was a secondary outcome measure. Toxicity was represented as odds ratios (ORs), and quality of life (QoL) data were extracted when present. MAIN RESULTS: This review included 29 studies (27 full-text publications and 2 abstracts or online theses). The updated analysis included 41,911 randomised women; the original review included 21,191 women. Taxane-containing regimens improved OS (HR 0.87, 95% confidence interval (CI) 0.83 to 0.92; high-certainty evidence; 27 studies; 39,180 women; 6501 deaths) and DFS (HR, 0.88, 95% CI 0.85 to 0.92; high-certainty evidence; 29 studies; 41,909 women; 10,271 reported events) compared to chemotherapy without a taxane. There was moderate to substantial heterogeneity across studies for OS and DFS (respectively).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; 10,842 women) and for DFS (HR 0.84, 95% CI 0.78 to 0.90; P < 0.001; 7 studies; 10,842 women). When a taxane-containing regimen was compared with the same regimen with another drug or drugs that were substituted for the taxane, a beneficial effect was observed for OS and DFS with the taxane-containing regimen (OS: HR 0.80, 95% CI 0.74 to 0.86; P < 0.001; 13 studies; 16,196 women; DFS: HR 0.83, 95% CI 0.78 to 0.88; P < 0.001; 14 studies; 16,823 women). 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; 22,055 women) 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; 22,055 women), although the benefit was marginal in studies of women both with and without lymph node-positive disease (HR 0.95, 95% CI 0.88 to 1.02; 9 studies; 12,998 women) and was not apparent in studies of women with lymph node-negative disease (HR 0.99, 95% CI 0.86 to 1.14; 3 studies; 6856 women).Taxanes probably result in a small increase in risk of febrile neutropenia (odds ratio (OR) 1.55, 95% CI 0.96 to 2.49; moderate-certainty evidence; 24 studies; 33,763 women) and likely lead to a large increase in grade 3/4 neuropathy (OR 6.89, 95% CI 3.23 to 14.71; P < 0.001; moderate-certainty evidence; 22 studies; 31,033 women). Taxanes probably cause little or no difference in cardiotoxicity compared to regimens without a taxane (OR 0.87, 95% CI 0.56 to 1.33; moderate-certainty evidence; 23 studies; 32,894 women). Seven studies reported low-quality evidence for QoL; overall, taxanes may make little or no difference in QoL compared to chemotherapy without a taxane during the follow-up period; however, the duration of follow-up differed across studies. Only one study, which was conducted in Europe, provided cost-effectiveness data. AUTHORS' CONCLUSIONS: This review of studies supports the use of taxane-containing adjuvant chemotherapy regimens, with improvement in overall survival and disease-free survival for women with operable early breast cancer. This benefit persisted when analyses strictly compared a taxane-containing regimen versus the same regimen without a taxane or the same regimen with another drug that was substituted for the taxane. Preliminary evidence suggests that taxanes are more effective for women with lymph node-positive disease than for those with lymph node-negative disease. Considerable heterogeneity across studies probably reflects the varying efficacy of the chemotherapy backbones of the comparator regimens used in these studies. This review update reports results that are remarkably consistent with those of the original review, and it is highly unlikely that this review will be updated, as new trials are assessing treatments based on more detailed breast cancer biology.

Revisión sistemática

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Revista European Journal of Surgical Oncology
Año 2017
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BACKGROUND: The effect of ovarian ablation or suppression (OAS) in premenopausal women with breast cancer is controversial. The overall survival (OS), disease-free survival (DFS) and adverse event of OAS versus no OAS were compared. METHODS: A literature review of EMBASE, Web of Science, PUBMED, and Cochrane Library was conducted. The hazard ratio (HR) and 95% confidence interval (CI) for OS and DFS, as well as risk ratio (RR) and 95% CI for adverse events were evaluated. I-squared statistic (I2) represents heterogeneity. RESULTS: Twenty-nine studies with a total of 21,249 women were included. In premenopausal women aged 40 years or younger, there were significant differences in OS (HR 0.78, 95% CI: 0.66-0.94, P=0.008, I2 = 0%) and DFS (HR 0.84, 95% CI: 0.73-0.97, P=0.02, I2 = 0%) between OAS and no OAS. In advanced stage breast cancer, a significant difference was found in OS (HR 0.76, 95% CI: 0.60-0.96, P=0.02, I2 = 0%). Patients treated with OAS had more chances to have hot flushes (RR 1.91, 95% CI: 1.62-2.26, P < 0.01, I2 = 0%) and vaginal dryness (RR 1.19, 95% CI: 1.08-1.31, P=0.0003, I2 = 0%). No significant difference in depression (RR 1.28, 95% CI: 0.94-1.74, P=0.12, I2 = 0%). CONCLUSIONS: The study shows that OAS plays a beneficial role in premenopausal women aged 40 years or younger and advanced stage breast cancer. However, OAS is associated with increase in hot flushes and vaginal dryness.

Revisión sistemática

No clasificado

Autores Zhao J , Liu J , Chen K , Li S , Wang Y , Yang Y , Deng H , Jia W , Rao N , Liu Q , Su F
Revista Breast cancer research and treatment
Año 2014
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Para evaluar la incidencia de amenorrea inducida por la quimioterapia (CIA) y su impacto terapéutico en pacientes con cáncer de mama premenopáusicas. Se realizó una búsqueda sistemática para identificar los estudios clínicos que compararon la incidencia de la CIA con diferentes regímenes de quimioterapia y los resultados oncológicos con y sin CIA. Se utilizaron los efectos fijos y modelos de efectos aleatorios para evaluar las estimaciones agrupadas. Los análisis de sensibilidad y heterogeneidad se realizaron para explorar la heterogeneidad entre los estudios y evaluar los efectos de la calidad del estudio. Se incluyó a un total de 15.916 pacientes con cáncer de mama premenopáusicas de 46 estudios. Los regímenes basados ​​en la ciclofosfamida, los regímenes basados ​​en taxanos, y / regímenes basados ​​en antraciclinas epirubicina todos aumentaron la incidencia de la CIA con agrupados odds ratio de 2,25 (IC del 95%: 1.26 a 4.3, P = 0,006), CI 1,26 (95% 1.11- 1,43, P = 0,0003) y 1,39 (IC del 95% 1,15 a 1,70, P = 0,0008), respectivamente. Los regímenes de combinación de tres medicamentos de ciclofosfamida, antraciclina / epirubicina y taxanos (CAT / CET) causaron la tasa más alta de la CIA en comparación con las otras tres combinaciones de fármacos (OR 1.41, IC 95%: 1,16 a 1,73; p = 0,0008). La terapia con tamoxifeno también se correlaciona con una mayor incidencia de la CIA, con un OR de 1,48. No se han encontrado pacientes con CIA para exhibir mejor supervivencia libre de enfermedad (DFS) y la supervivencia global (SG) en comparación con los pacientes sin CIA. Con respecto al subtipo molecular, esta ventaja DFS siguió siendo significativa en pacientes sensibles a las hormonas (HR 0.61, IC 95% 0,52-0,72; p <0,00001). El meta-análisis actual ha demostrado que antraciclina / epirubicina, taxanos, ciclofosfamida y tamoxifeno contribuido a tasas elevadas de la CIA, y la CIA no era más que un efecto secundario de la quimioterapia, pero era un mejor marcador pronóstico, sobre todo para mujeres premenopáusicas con RE positivos temprano pacientes con cáncer de mama estadio en. Sin embargo, este tema merece aleatorizados más estudios de control para detectar las asociaciones entre la CIA y el pronóstico del paciente después de ajustar por la edad, la condición de ER, y otros factores influyentes.

Revisión sistemática

No clasificado

Autores Paxton R.J. , Jones L.A.
Revista Breast Diseases
Año 2012
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Revisión sistemática

No clasificado

Autores Shao N , Wang S , Yao C , Xu X , Zhang Y , Zhang Y , Lin Y
Revista Breast (Edinburgh, Scotland)
Año 2012
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OBJETIVO: Se realizó un meta-análisis de ensayos aleatorios de fase III para comparar los resultados del tratamiento para las pacientes con cáncer de mama que reciben quimioterapia adyuvante con antraciclinas secuenciales o concurrentes y taxanos. MÉTODOS: Todos los ensayos de fase III aleatorizados que compararon la quimioterapia adyuvante de antraciclinas secuenciales o concurrentes y taxanos en pacientes en estadio temprano de cáncer de mama fueron considerados elegibles. Un total de tres ensayos que reclutaron 8728 mujeres fueron analizados. Un análisis conjunto se llevó a cabo y basadas en eventos razones de riesgo (RR) con intervalos de confianza del 95% (95% IC) se derivan. Las diferencias significativas en la supervivencia libre de enfermedad (DFS) y la supervivencia general (SG) fueron exploradas. Una prueba de heterogeneidad se aplicó también. RESULTADOS: De los tres ensayos elegibles, las diferencias significativas a favor del régimen secuencial se observaron en DFS (RR: 0.90, IC 95%: 0,84 a 0,98; P = 0,01) y en la SG (RR: 0.88, IC 95%: 0,79 a 0,98 , p = 0,02). Conclusión: Teniendo en cuenta todos los disponibles ensayos de fase III, la quimioterapia adyuvante secuencial para el cáncer de mama precoz parece añadir un beneficio significativo en tanto la SSE y la SG sobre los regímenes concurrentes.

Revisión sistemática

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ANTECEDENTES: En los ensayos de 5 años de tamoxifeno en el cáncer de mama precoz madurez, la relevancia de las mediciones de receptores de hormonas (y otras características de los pacientes) a largo plazo los resultados pueden ser evaluados cada vez más fiable. Presentamos actualizados los meta-análisis de los ensayos de 5 años de tamoxifeno adyuvante. MÉTODOS: Se llevó a cabo una colaboración meta-análisis de datos de pacientes individuales a partir de 20 ensayos (n = 21.457) en el cáncer de mama en fase inicial de alrededor de 5 años de tamoxifeno versus ningún tratamiento adyuvante con tamoxifeno, con el cumplimiento de alrededor del 80%. Relaciones de recurrencia y de mortalidad (RR) fueron de los análisis de log-rank por el tratamiento asignado. RESULTADOS: En los receptores de estrógenos (ER) positivos a la enfermedad (n = 10.645), la asignación a los 5 años de tamoxifeno reduce sustancialmente las tasas de recurrencia en los primeros 10 años (RR 0,53 [0,03 SE] durante los años 0-4 y RR 0,68 [0,06] durante los años 5-9 [tanto 2p <0,00001], pero RR 0,97 [0,10] durante los años 10-14, sugiriendo que no hay ganancia o pérdida después de más de 10 años). Incluso en la enfermedad de forma marginal ER-positivo (10-19 fmol / mg de proteína citosólica) la reducción de la recurrencia fue sustancial (RR 0,67 [0,08]). En ER-positivos a la enfermedad, el RR fue de aproximadamente independiente del estado del receptor de progesterona (o nivel), edad, estado ganglionar, o el uso de la quimioterapia. La mortalidad del cáncer de mama se redujo en un tercio durante los primeros 15 años (RR 0,71 [0,05] durante los años 0-4, 0,66 [0,05] durante los años 5-9, y 0.68 [0 · 08] en los años 10-14, p <0,0001 para la reducción de la mortalidad adicional durante cada período de tiempo por separado). En general no la mortalidad por cáncer de mama se vio poco afectada, a pesar de pequeños incrementos absolutos en la mortalidad por cáncer tromboembólica y de útero (ambos sólo en las mujeres mayores de 55 años), por lo que todas las causas de la mortalidad se redujo sustancialmente. En ER-negativo enfermedad, el tamoxifeno tenían poco o ningún efecto sobre la recurrencia del cáncer de mama o la mortalidad. INTERPRETACIÓN: 5 años de tamoxifeno adyuvante reduce de forma segura a 15 años los riesgos de recurrencia del cáncer de mama y la muerte. ER fue el único factor predictivo importante registrado de las reducciones proporcionales. Por lo tanto, las reducciones del riesgo absoluto producido por el tamoxifeno dependerá de los riesgos de cáncer de mama absolutos (después de una quimioterapia) sin tamoxifeno. FINANCIACIÓN: Cancer Research UK, la Fundación Británica del Corazón y del Medical Research Council.