Die palliative Behandlung des metastasierten Mammakarzinoms mit Taxanen: Ein Wirkungsvergleich zwischen Docetaxel und Paclitaxel mittels Matched-Pair-Analyse

Zusammenfassung

Um die Wirksamkeit und Toxizität von Docetaxel und Paclitaxel bei der Behandlung von Patientinnen mit metastasiertem Mammakarzinom zu vergleichen, analysierten wir retrospektiv den Krankheitsverlauf der seit 1992 in unserer Institution behandelten Patientinnen. 43 Patientinnen mit metastasiertem Mammakarzinom, die mit einem Docetaxel- haltigen Therapieregime behandelt wurden, konnten einer Kontrollgruppe von 43 Patientinnen mit der gleichen Anzahl an Vortherapien gegenübergestellt werden, die ein vergleichbares Paclitaxel- haltiges Schema erhalten hatten. Die Toxizität war in beiden Behandlungsgruppen gering. Die klinische Tumorkontrollrate (komplette oder partielle Remission oder Tumorstabilisierung für mindestens 6 Monate) lag bei Docetaxel signifikant höher als bei Paclitaxel (67 % vs. 44 %, p = 0,001). Auch waren weniger Patientinnen unter der Behandlung mit Docetaxel progredient (28 % vs. 53 %, p < 0,001). Nach einer medianen Beobachtungszeit von 17 Monaten (Spanne 5-61 Monate) bestand kein signifikanter Unterschied bezüglich der medianen progressionsfreier Zeit (7 vs. 5 Monate, p = 0,123) und der medianen Überlebenszeit (12 vs. 11 Monate, p = 0,211) zwischen beiden Gruppen. Die nach der Methode von Kaplan und Meier [17]geschätzten 1-Jahres- (74 % vs. 62 %) und 2-Jahres-Überlebensraten (50 % vs. 26 %) favorisierten allerdings eine Behandlung mit Docetaxel. Ein positiver Hormonrezeptorstatus war der einzige unabhängige Prognosefaktor für ein längeres Ü berleben in der multivariaten Analyse. Diesen Ergebnissen zufolge könnte Docetaxel beim metastasierten Mammakarzinom möglicherweise wirksamer sein als Paclitaxel.

Taxane-based palliative chemotherapy for metastatic breast cancer: matched pair analysis to compare the efficacy and safety of docetaxel and paclitaxel

Summary

Objective: A retrospective comparison of the efficacy and toxicity of docetaxel and paclitaxel in the treatment of metastatic breast cancer (MBC) was conducted based on our institution's experience since 1992. Methods: Two groups of 43 patients who received a similar chemotherapy regimen containing either docetaxel or paclitaxel were matched for the number of prior treatments. Results: Toxicity was mild in both groups. Tumour growth control, defined as either objective response or stable disease for at least 6 months, was obtained in a significantly higher proportion of patients treated with docetaxel compared with paclitaxel (67 % vs. 44 %, p = 0.001). Moreover, fewer patients progressed during treatment with docetaxel (28 % vs. 53 %, p < 0.001). At a median follow-up of 17 months there was no significant difference between the groups in median progression-free survival (7 vs. 5 months, p = 0.123) or median overall survival (OS) (12 vs. 11 months, p = 0.211). According to the method of Kaplan and Meier [17] estimated OS rates at 1 year (74 % vs. 62 %) and 2 years (50 % vs. 26 %), however, were in favour of docetaxel. In a multivariate analysis only a positive hormone receptor status was significantly associated with improved OS. Conclusion: These results suggest that docetaxel may be superior to paclitaxel in the treatment of MBC.

Docetaxel - Paclitaxel - metastasiertes Mammakarzinom - Ansprechen - Überleben

Docetaxel - paclitaxel - metastatic breast cancer - response - survival

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