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Meta-Analysis
. 2024 Aug 3;31(8):4486-4506.
doi: 10.3390/curroncol31080335.

The Omission of Anthracycline Chemotherapy in Women with Early HER2-Negative Breast Cancer-A Systematic Review and Meta-Analysis

Danilo Giffoni de Mello Morais Mata  1   2 , Mary-Beth Rush  3 , Megan Smith-Uffen  4 , Jawaid Younus  1   2 , Ana Elisa Lohmann  1   2 , Maureen Trudeau  5   6 , Rebecca L Morgan  3   7
Affiliations
Meta-Analysis

The Omission of Anthracycline Chemotherapy in Women with Early HER2-Negative Breast Cancer-A Systematic Review and Meta-Analysis

Danilo Giffoni de Mello Morais Mata et al. Curr Oncol. .

Abstract

Background: Anthracycline-taxane is the standard chemotherapy strategy for treating high-risk early breast cancer despite the potentially life-threatening adverse events caused by anthracyclines. Commonly, the combination of docetaxel and cyclophosphamide (TC) is considered an alternative option. However, the efficacy of TC compared to anthracycline-taxane chemotherapy is unclear. This study compares disease-free survival (DFS), overall survival (OS) and cardiotoxicity between adjuvant TC and anthracycline-taxane for stages I-III, HER2-negative breast cancer.

Methods: A systematic search on MEDLINE, Embase and Cochrane CENTRAL for randomized-controlled trials published until 11 March 2024, yielded 203 studies with 11,803 patients, and seven trials were included.

Results: TC results in little to no difference in DFS (HR 1.09, 95% CI 0.98-1.20; moderate-certainty of evidence); OS (1.02, 95% CI 0.89-1.16; high-certainty of evidence); and cardiotoxicity (RR 0.54, 95% CI 0.16-1.76; high-certainty of evidence), compared to anthracycline-taxane. In the subgroup analysis, patients with ≥4 lymph nodes had improved DFS from anthracycline-taxane over TC.

Conclusions: Overall, there was no difference between TC and anthracycline-taxane in DFS, OS and cardiotoxicity. In women with ≥4 nodes, anthracycline-taxane was associated with a substantial reduction in relapse events, compared to TC. Our study supports the current standard of practice, which is to use anthracycline-taxane and TC chemotherapy as a reasonable option in select cases.

Keywords: adjuvant; cyclophosphamide; docetaxel; doxorubicin; endocrine (hormone) receptor; epirubicin; human epidermal growth factor receptor 2 negative; invasive carcinoma; paclitaxel.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure A1
Figure A1
Baseline risk estimation of DFS events.
Figure A2
Figure A2
Baseline risk estimation of OS events.
Figure A3
Figure A3
Baseline risk estimation of cardiotoxicity.
Figure A4
Figure A4
Forest plot of DFS comparing TC and anthracycline-taxane chemotherapy in a subgroup analysis of lymph node-negative [33,52,55].
Figure A5
Figure A5
Forest plot of OS comparing TC and anthracycline-taxane chemotherapy in a subgroup analysis of lymph node-positive [54,55].
Figure 1
Figure 1
Study flow PRISMA diagram.
Figure 2
Figure 2
(A) Risk of bias summary by domain for disease-free survival. (B) Risk of bias summary by domain for overall survival [33,46,51,52,54,55] (color should be used in print version of these figures).
Figure 3
Figure 3
Forest plot of DFS comparing TC and anthracycline-taxane chemotherapy [33,46,51,52,54,55].
Figure 4
Figure 4
Forest plot of OS comparing TC and anthracycline-taxane chemotherapy [33,46,51,52,54,55].
Figure 5
Figure 5
Forest plot of cardiotoxicity comparing TC and anthracycline chemotherapy [33,46,51,55].
Figure 6
Figure 6
Forest plot of DFS comparing TC and anthracycline-taxane chemotherapy in a subgroup analysis of ER status [33,46,51,54].
Figure 7
Figure 7
Forest plot of DFS comparing TC and anthracycline-taxane chemotherapy in a subgroup analysis of lymph node-positive [33,51,52,54,55].
See this image and copyright information in PMC

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