A phase II study of single agent paclitaxel in patients at first relapse following initial chemotherapy for breast cancer

Taxane-induced arthralgia and myalgia: A literature review

Purpose

Arthralgia and myalgia following taxane chemotherapy has been documented in the literature. However, these two toxicities associated with taxane treatment have not been closely examined in the literature, and data remain inconsistent in terms of the reported incidences of these toxicities. The purpose of this literature review was to provide a more comprehensive understanding of the incidence of taxane-induced arthralgia and myalgia, as well as to document the risk factors and preventative and therapeutic treatments that have been investigated.

Methods

A literature search was conducted in Ovid Medline, OldMedline, Embase, Embase Classic, and Cochrane Central Register of Controlled Trials using relevant subject headings and keywords such as: “arthralgia,” “myalgia,” “muscle pain,” “joint pain,” “taxane,” “chemotherapy,” “docetaxel,” “paclitaxel.”

Results

The reported incidences of arthralgia and myalgia were variable. Taxane chemotherapy was found to be associated with greater incidences of arthralgia and myalgia than non-taxane forms of chemotherapy. Moreover, docetaxel and nab-paclitaxel seem to be associated with lower incidences of arthralgia and myalgia than paclitaxel. Finally, the literature on prevention and therapeutic treatment of taxane-induced arthralgia and myalgia is scarce.

Conclusion

More studies should be done in order to more conclusively identify optimal therapeutic and preventative treatments as well as different risk factors. We recommend that a prospective study be done in order to better understand the true incidence of arthralgia and myalgia in patients being treated with the paclitaxel, docetaxel, and nab-paclitaxel.

Weekly Paclitaxel plus Capecitabine versus Docetaxel Every 3 Weeks plus Capecitabine in Metastatic Breast Cancer

Background. We performed a randomized phase II study comparing efficacy and toxicity of weekly paclitaxel 80 mg/m(2) (Weetax) with three weekly docetaxel 75 mg/m(2) (Threetax), both in combination with oral capecitabine 1000 mg/m(2) twice daily for 2 weeks followed by a 1-week break. Patients. Thirty-seven women with confirmed metastatic breast cancer were randomized. Results. Median TTF was 174 (Weetax) versus 147 days (Threetax) (P=0.472). Median OS was 933 (Weetax) versus 464 days (Threetax) (P=0.191). Reasons for TTF were PD 8/18 (Weetax), 9/19 (Threetax); and toxicity: 8/18 (Weetax), 8/19 (Threetax). ORR was 72% (Weetax) versus 26% (Threetax) (P = 0.01). The Threetax-combination resulted in a higher incidence of leuco-/neutropenia compared to Weetax. Grade II anemia was more pronounced in the Weetax group. No difference was found in quality of life. Conclusion. Taxanes in combination with capecitabine resulted in a high level of toxicity. Taxanes and capecitabine should be considered given sequentially and not in combination.

A prospective trial of preoperative chemotherapy in resectable breast cancer: predictors of breast-conservation therapy feasibility

BACKGROUND

The role of preoperative chemotherapy for breast cancer is evolving. We initiated a prospective trial of sequential preoperative paclitaxel and doxorubicin-based combination chemotherapy in patients with stage I (tumor >1 cm), II, or IIIA disease and evaluated its effect on breast-conservation therapy (BCT) eligibility.

METHODS

Pathology findings for the initial 100 consecutive patients who underwent surgery were analyzed.

RESULTS

The median tumor size at presentation was 2.4 cm, and 39% of patients were deemed eligible for BCT. After chemotherapy, the median tumor size decreased to 1.0 cm (P <.001), and 59% of patients seemed BCT eligible (BCT conversion rate 34% among patients initially assessed as BCT ineligible; P <.001). Final pathology confirmed BCT feasibility in 90% of patients assessed as BCT candidates before surgery. The pathology from mastectomy specimens revealed BCT feasibility in 11 (27%) of 41 patients deemed BCT ineligible. Multivariate analysis revealed lobular histology, multicentricity, and calcifications, but not age, initial tumor size, or nodal status to predict final pathology indicating BCT ineligibility.

CONCLUSIONS

Induction chemotherapy improves BCT eligibility for breast cancer patients. Improved breast imaging methods after chemotherapy are necessary to improve accuracy in predicting the feasibility of BCT, especially in patients presenting with diffuse calcifications or multicentricity.