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New Developments in Taxane -based Combinations

New Developments in Taxane -based Combinations. Dott. Michele De Laurentiis. Dip. di Endocrinologia ed Oncologia Molecolare e Clinica. Università Federico II --- Napoli, Italia. Adjuvant Chemo at MDACC. Shen et al. Cancer 2009. Anthra / Taxanes in the Adjuvant Setting A Survey.

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New Developments in Taxane -based Combinations

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  1. New Developments in Taxane-based Combinations Dott. Michele De Laurentiis Dip. di Endocrinologia ed Oncologia Molecolare e Clinica Università Federico II --- Napoli, Italia

  2. AdjuvantChemo at MDACC Shenet al. Cancer 2009

  3. Anthra/Taxanes in the AdjuvantSettingA Survey Verma & Clemons, The Oncologist 2007

  4. De Laurentiis et al, J Clin Oncol, 2008 Anthra/Taxanes in the Adjuvant SettingA Metanalysis of Randomized Trials (N=22,903) HR for Relapse 0.0 0.5 1.0 1.5 2.0 Favors taxanes Favors Control

  5. De Laurentiis et al, J Clin Oncol, 2008 Anthra/Taxanes in the Adjuvant SettingA Metanalysis of Randomized Trials (N=22,903) HR for Death 0.0 0.5 1.0 1.5 2.0 Favors taxanes Favors Control

  6. DFS 1.0 0.96 0.89 0.96 0.9 0.81 0.87 0.8 0.72 0.78 Proportion disease free 0.7 0.62 0.67 0.6 0.57 0.5 0.0 0 1 2 3 4 5 Years Anthra/Taxanes in the Adjuvant Setting Metanalysis of Randomized Trials (N=22,903) De Laurentiis et al, J Clin Oncol, 2008

  7. OS 0.99 1.0 0.95 0.91 0.99 0.9 0.95 0.84 0.89 0.77 0.8 0.82 0.7 0.74 Proportion surviving 0.6 0.5 0.0 0 1 2 3 4 5 Years Anthra/Taxanes in the Adjuvant Setting Metanalysis of Randomized Trials (N=22,903) De Laurentiis et al, J Clin Oncol, 2008

  8. Peto R, SABCS 2007

  9. Peto R, SABCS 2007

  10. Controversial Issues • Taxanes • New conflicting data • WhichTaxane/Schedule? • ER+ and/or HER2- do not benefit

  11. N=2089 N=2073 Ellis et al. Lancet2009

  12. Ellis et al. Lancet2009

  13. Anthra/Taxanes in Node-Negative pts The GEICAM9805 Trial Martin et al, ESMO 2008

  14. Anthra/Taxanes in N1-3 pts The EC-Doc Trial EC- Doc FEC HR:1.514 (95% CI 1.11 – 2.07) log rank p = 0.009 (two sided) EC-Doc: 74 events FEC: 84 events Nitzet al, SABCS 2008

  15. De Laurentiis et al, Unpublished Data

  16. Controversial Issues • Taxanes • New conflicting data • WhichTaxane/Schedule? • ER+ and/or HER2- do not benefit

  17. De Laurentiis et al, J Clin Oncol, 2008 Anthra/Taxanes in the Adjuvant SettingA Metanalysis of Randomized Trials (N=22,903) HR for Relapse 0.0 0.5 1.0 1.5 2.0 Favors taxanes Favors Control

  18. Anthra/Taxanes: Concurrent vs Sequential The Big2-98 Trial Francis et al, JNCI 2008

  19. Eiermannet al, SABCS 2008

  20. Docetaxel vs Paclitaxel & Weekly vs Three-weekly The E1199 Trial Sparano et al, NEJM 2008

  21. Docetaxel vs Paclitaxel & Weekly vs Three-weekly The E1199 Trial Overall Sparano et al, NEJM 2008

  22. Controversial Issues • Taxanes • New conflicting data • WhichTaxane/Schedule? • ER+ and/or HER2- do not benefit

  23. De Laurentiis et al, Unpublished Data

  24. MetanalysisofTaxanesby HER2 statusDisease-freeSurvival De Laurentiiset al. SABCS08

  25. MetanalysisofTaxanesby ER/HER2Disease-freeSurvival De Laurentiiset al. Unpublished Data

  26. Conclusions • Anthra/Taxanescombinations standard option in moderate/high risk EBC • Optimizationissuesneedstobecleared • Weeklypaclitaxel and three-weeklydocetaxelpreferredoptions • ER and HER2 status notclearlyhelpfultoidentifypatientswho do not benefit from A/T combinations

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