Fourteen RCTs were included in the review. These included 1 RCT (429 patients) of docetaxel as first-line treatment for breast cancer, 4 RCTs (1,545 patients) of paclitaxel as first-line treatment for breast cancer, 4 RCTs (1,092 patients) of docetaxel as second-line treatment for breast cancer, and 1 RCT (81 patients) of paclitaxel as second-line treatment for breast cancer. There were also 4 RCTs (3,746 patients) of paclitaxel as first-line treatment for ovarian cancer.
Paclitaxel for first-line treatment for breast cancer (4 RCTs):
Three trials looked at single-agent paclitaxel. The median progression-free survival in the paclitaxel arm ranged from 4 to 5.9 months; in no trial was this greater than the control arm. In one trial, the anthracycline group had significantly longer progression-free survival than single-agent paclitaxel (7.5 versus 4.0 months, p=0.0001). The median length of overall survival in the paclitaxel arm ranged from 17.3 to 22.2 months; in no trial was this significantly different to the control. One of these trials compared single-agent paclitaxel with combined paclitaxel plus anthracycline, for which survival was similar in both arms (22.2 versus 22 months).
Two trials looked at the combination of paclitaxel with anthracycline. The median progression-free survival in the intervention arms ranged from 8 to 8.3 months. In both trials this was significantly greater than the control arm (8 versus 6 months, p=0.003; in one trial; 8.3 versus 6.2 months, p=0.034, in the second). The median length of overall survival for patients in the paclitaxel-anthracycline combination arm ranged from 22 to 22.7 months. Patients in the paclitaxel-anthracycline arm survived for significantly longer than control in one trial (22.7 versus 18.3 months, p=0.02) but not in the other (22 versus 18.9 months, p=0.24), although the difference was comparable.
QOL was evaluated in 3 trials (one looking at paclitaxel as a single agent and two looking at paclitaxel in combination with anthracycline). There was no significant difference between paclitaxel and control in any of the trials in terms of overall QOL, although differences were apparent on some subscales. These did not appear to follow a consistent pattern across the trials.
Docetaxel for first-line treatment for breast cancer (1 RCT):
One RCT was identified which was published as an abstract only and of poor quality. A combination of docetaxel and doxorubicin produced a greater overall response than doxorubicin and cyclophosphamide combined, there were no long-term results such as progression-free or overall survival.
Paclitaxel for second-line treatment for breast cancer (1 RCT):
The median progression-free survival in the paclitaxel arm was 3.5 months. This was significantly longer than the mitomycin control arm (1.6 months, p=0.026). The median overall survival in the paclitaxel arm was 12.7 months, compared with 8.4 months in the mitomycin arm. QOL was not reported.
Docetaxel for second-line treatment for breast cancer (4 RCTs):
The median progression-free survival in the docetaxel arm ranged from 4.75 to 7 months. Patients in the docetaxel arms of 2 RCTs had significantly longer progression-free survivals than controls (4.75 versus 2.75 months, p=0.001; 6.3 versus 3 months, p=0.001). The median overall survival in the docetaxel arm ranged from 10.4 to 15 months. Patients in the docetaxel arm of one trial survived for significantly longer than the mitomycin plus vinblastine arm (11.4 versus 8.7 months, p=0.03).
QOL was evaluated in 2 trials. There was no significant difference between docetaxel and control in either of these trials in terms of global health status, although differences were apparent on some subscales. These did not appear to follow a consistent pattern across trials.
Paclitaxel for first-line treatment for ovarian cancer (4 RCTs):
The median progression-free survival in the paclitaxel-platinum arm ranged from 14.1 to 18 months. Patients in 2 trials had significantly greater progression-free survivals with paclitaxel-platinum than controls (18 versus 13 months, p<0.001; 16.5 versus 11.8 months, p=0.001). The median length of overall survival in the paclitaxel- platinum arm ranged from 26.6 to 38 months. Patients in 2 trials had significantly greater overall survivals with paclitaxel-platinum than controls (38 versus 24 months, p<0.001; 35 versus 25 months, p=0.001). QOL was not reported.