Review - Haymarket Media Group

Commentary
ed in a high rate of failure to complete the 12 weeks
of taxane therapy. Some have argued that if a greater
proportion of patients had completed therapy on the
docetaxel arms, the survival for those arms would
have been superior to the paclitaxel arms. I would
argue that survival for patients on the weekly paclitaxel
arm was at least as good as for patients on any
of the other treatment arms, and the toxicity was less,
making it better tolerated and therefore the preferred
treatment.
The results of this study are consistent with other
studies that suggest that weekly paclitaxel is superior
to every-3-week paclitaxel, and that every-3-week
docetaxel is superior to weekly docetaxel. Why the
optimal schedule is different for the two taxanes is
not known. This is supported by the study by
Seidman and colleagues of paclitaxel in the metastatic
setting, as well as by studies of docetaxel in breast
cancer and other diseases. 6,7
One question that remains unanswered is the
comparative efficacy of weekly paclitaxel versus
dose-dense paclitaxel (administered every 2 weeks).
Citron and colleagues demonstrated that cyclophosphamide
and doxorubicin followed by paclitaxel
was more effective if administered every 2 weeks
versus every 3 weeks. 8 Sparano and colleagues
administered the cyclophosphamide/doxorubicin
cycles every 3 weeks and compared weekly taxane
versus every-3-week taxane. Although there is no
direct comparison between weekly and dose-dense
paclitaxel, one might expect them to be roughly
similar based on the relative advantage of each of
these regimens when compared with every-3-week
therapy.
Finally, one must ask why it has taken us so long
to determine optimal dose schedules for one of the
most widely used and effective classes of therapies
16 The American Journal of Hematology/Oncology
for breast cancer – the taxanes – which has been in
our armamentarium for quite a long time. F
References
1. Sparano JA, Wang M, Martino S, et al. Weekly paclitaxel in the
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2. Winer E, Berry D, Woolf S, et al. Failure of higher-dose paclitaxel
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2004;22:2061-2068.
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study of docetaxel compared with paclitaxel in metastatic
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6. Seidman AD, Berry D, Cirrincione C, et al. CALGB 9840: phase
III study of weekly (W) paclitaxel (P) via 1-hour (h) infusion
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of metastatic breast cancer (MBC), with trastuzumab (T)
for HER2 positive MBC and randomized for T in HER2 normal
MBC. J Clin Oncol. 2004;22(July 15 suppl):6s. Abstract 512.
7. Burstein H, Manola J, Younger J, et al. Docetaxel administered
on a weekly basis for metastatic breast cancer. J Clin Oncol.
2000;18:1212-1219.
8. Citron ML, Berry DA, Cirrincione C, et al. Randomized trial of
dose-dense versus conventionally scheduled and sequential
versus concurrent combination chemotherapy as postoperative
adjuvant treatment of node-positive primary breast cancer:
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J Clin Oncol. 2003;21:2226]. J Clin Oncol. 2003;21:1431-1439.
Author disclosures: consultant: EMD Serono, Serenex.
Correspondence address: Lawrence N. Shulman, MD, Dana-
Farber Cancer Institute, 44 Binney Street, Boston, MA 02115;
phone: (617) 632-2277; fax: (617) 632-2260; e-mail: Lawrence_
Shulman@dfci.harvard.edu.