Adjuvant Chemotherapy, with or without Taxanes, in Early or Operable Breast Cancer: A Meta-Analysis of 19 Randomized Trials with 30698 Patients
in Early or Operable Breast Cancer: A Meta-Analysis
of 19 Randomized Trials with 30698 Patients. PLoS ONE 6(11): e26946. doi:10.1371/journal.pone.0026946
Adjuvant Chemotherapy, with or without Taxanes, in Early or Operable Breast Cancer: A Meta-Analysis of 19 Randomized Trials with 30698 Patients
Ying-Yi Qin 0
Hui Li 0
Xiao-Jing Guo 0
Xiao-Fei Ye 0
Xin Wei 0
Yu-Hao Zhou 0
Xin-Ji Zhang 0
Chao Wang 0
Wei Qian 0
Jian Lu 0
Jia He 0
John D. Minna, Univesity of Texas Southwestern Medical Center at Dallas, United States of America
0 1 Department of Health Statistics, Second Military Medical University , Shanghai , China , 2 Clinical Medicine, College of Basic Medicine, Shanghai Jiaotong University School of Medicine , Shanghai , China
Background: Taxanes have been extensively used as adjuvant chemotherapy for the treatment of early or operable breast cancer, particularly in high risk, node-negative breast cancer. Previous studies, however, have reported inconsistent findings regarding their clinical efficacy and safety. We investigated disease-free survival (DFS), overall survival (OS), and drug-related toxicities of taxanes by a systematic review and meta-analysis. Methodology and Principal Findings: We systematically searched PubMed, EMBASE, the Cochrane Center Register of Controlled Trials, proceedings of major meetings, and reference lists of articles for studies conducted between January 1980 and April 2011. Randomized controlled trials (RCTs) comparing chemotherapy with and without taxanes in the treatment of patients with early-stage or operable breast cancer were eligible for inclusion in our analysis. The primary endpoint was DFS. Nineteen RCTs including 30698 patients were identified, including 8426 recurrence events and 3803 deaths. Taxanes administration yielded a 17% reduction of hazard ratio (HR) for DFS (HR = 0.83, 95% CI 0.79-0.88, p,0.001) and a 17% reduction of HR for OS (HR = 0.83, 95% CI 0.77-0.90, p,0.001). For high risk, node-negative breast cancer, the pooled HR also favoured the taxane-based treatment arm over the taxane-free treatment arm (HR = 0.82, 95% CI 0.77-0.87, p = 0.022). A significantly increased rate of neutropenia, febrile neutropenia, fatigue, diarrhea, stomatitis, and oedema was observed in the taxane-based treatment arm. Conclusions/Significance: Adjuvant chemotherapy with taxanes could reduce the risk of cancer recurrence and death in patients with early or operable breast cancer, although the drug-related toxicities should be balanced. Furthermore, we also demonstrated that patients with high risk, node-negative breast cancer also benefited from taxanes therapy, a result that was not observed in previous studies.
Funding: National Nature Science Foundation of China (30872186, 81072388), a grant from the leading talents of science in Shanghai 2010 (022) and a grant
sponsored by Program of Shanghai Subject Chief Scientist (09XD1405500). The funders had no role in the study design, data collection, analysis, decision to
publish or preparation of the manuscript. The corresponding author had full access to all the data in the study and had the final responsibility for the decision to
submit for publication.
Competing Interests: The authors have declared that no competing interests exist.
. These authors contributed equally to this work.
Breast cancer (BC) is a leading cause of morbidity and mortality
among women worldwide . Most BCs (.75%) are diagnosed
at an early stage or are operable . For these patients, it is
essential to administer adjuvant chemotherapy to reduce the risk
of recurrence . Taxanes(paclitaxel or docetaxel) are active
cytotoxic agents that promote polymerization of tubulin and
stabilization of microtubules by preventing their disassembly.
Recently, several randomized trials have been conducted to
identify the efficacy and safety of taxane-based adjuvant
chemotherapy for early or operable BC, often with conflicting
results. Additionally, the efficacy of taxanes for patients with high
risk, node-negative BC remains uncertain. Two previous
metaanalyses  have been conducted to determine the efficacy and
safety of this agent in patients with BC although investigators did
not present the efficacy of taxanes in node-negative BC. We
undertook a meta-analysis to update the results and resolve the
uncertain efficacy of taxanes in women with node-negative BC.
Furthermore, we also reported the efficacy of taxanes treatment in
some specific subgroups.
Search strategy and selection criteria
Randomized controlled trials (RCTs) and literatures trials
resulted of taxane therapy were eligible for inclusion in our
meta-analysis, with no restriction on language or publication status
(i.e., published, unpublished, in press or in progress). The search
process was initiated as follows:
(1) Electronic databases (from January 1980 to April 2011): We
retrieved literatures from PubMed, EmBase and the
Cochrane Center Register of Controlled Trials, using the search
terms of early breast cancer, operable breast cancer,
node-negative breast cancer, stage I or stage II breast
cancer, and docetaxel or taxane or paclitaxel.
(2) Additional resources: Two important annual meetings
including American Society of Clinical Oncology Annual
Scientific Meeting (ASCO) and the San Antonio Breast
Cancer Symposium (from 1995 to 2011), were manually
searched. In addition, information about registered
randomized controlled trials was obtained from the website http://
clinicaltrials.gov/ (US NIH). Relevant reviews and
metaanalyses regarding the role of taxane-based adjuvant
chemotherapy in patients with early or operable BC were examined
for potential trials.
This review was conducted and reported according to the
PRISMA (Preferred Reporting Items for Systematic Reviews and
Meta-Analysis) Statement issued in 2009 (Checklist S1) .
The eligible RCTs should meet the following inclusion criteria:
(a) early or operable BC; (b) high quality RCT comparing a
taxane-based adjuvant chemotherapy arm with a taxane-free
adjuvant chemotherapy arm; and (c) the primary outcome was
either disease-free survival (DFS) or overall survival (OS). Search
and selection of studies was conducted independently by 2
investigators (Y-YQ and X-JG).
Data extraction and quality assessment
Data extraction and quality assessment were conducted
independently by 2 investigators (Y-YQ and HL) using a
standardized data recording form and Jadad scale . Information
was examined and adjudicated independently by 2 additional
investigators (X-FY and Y-HZ) referring to the original articles
after data extraction and assessment.
The following information was extracted from each eligible
study: study design, year of publication, number of patients,
regimen details, median follow-up, median age, node status, main
endpoint, the hazard ratios (HRs) and corresponding 95%
confidence interval (CI), and the drug-related toxicities (WHO
grades $3). For studies which reported HRs for the taxane-free
treatment arm rather than the taxane-based treatment arm, HRs
were recalculated by the exponential of negative ln(HR). If HRs
and 95% CIs were not directly obtained from the original articles,
they were estimated indirectly using reported events in each arm
and the corresponding P value as suggested by Tierney et al .
If information could not be obtained from the original literature,
direct communication with the authors was initiated. The
quantitative 5-point Jadad scale was used as a gauge to assess
the quality of the inclusive trials in our study.
The primary efficacy outcome of our meta-analysis was
diseasefree survival (DFS). DFS was defined as time from randomization
to any recurrence of BC (local or distant), new primary BC, a
second cancer, or death. The subgroup analyses were
prospectively planned according to node status, drug dosage, schedule,
observation period, menopausal status, hormone receptor status,
and tumor size. Interaction tests were performed to compare
differences between the 2 estimates . The adverse events (AEs)
of taxane-based treatment were analyzed as drug-related toxicities
(WHO grades $3). The pooled estimation plotted as odd ratios
(ORs) was obtained . A pooled OR and 95% CI greater than
1 indicated a statistically significant result.
Heterogeneity between trials was evaluated by chi-square (x2)
test and I-squared (I2) statistic . These indices assess the
percentage of variability across studies attributable to
heterogeneity rather than chance. Statistical heterogeneity was considered
significant when p,0.10 for the x2 test or I2.50%. Although
fixed-effects model and random-effects model yielded similar
conclusions, we chose to use the random-effects model, which
assumed that the true underlying effect varied among included
trials. Moreover, many investigators consider that the
randomeffects model to be a more natural choice than fixed effects model
in medical decision-making contexts . The probability of
publication bias was assessed with the funnel plots and the
BeggMazumdar test . Additionally, the pooled HR estimates were
recalculated after excluding low-scoring trials to test their
sensitivity. All reported P values were two-sided and P values less
than 0.05 were regarded as statistically significant. Statistical
analyses were carried out using STATA 11.0 (Stata Corporation,
Lakeway, Texas, USA).
Twenty-two potential trials were identified and 3 trials 
of them were excluded for specific reasons listed in flow chart
(Figure 1 and Protocol S1 ). The remaining 19 trials 
included 30698 women with early or operable BC. Two trails
[3031,33] were published in abstracts and the remaining 17
trials [2027,29,32,3437,3942] were published in full articles.
All of the trials included were open-label, phase III, randomized
trials. Concurrent regimens were conducted in 5 trials
[20,22,25,27,37], while sequential regimens were tested in the
remaining 14 trials [21,2324,2930,3236,38,4042]. The
GEICAM 9805  recruited patients with node-negative breast
cancer, and the ECTO trial  only recruited patients with
tumor size .2 cm. Recurrence/relapse-free survival (RFS) was
the main endpoint of FinHer and Boccardo et al [23,34], and
freedom from progression (FFP) was the main endpoint of the
ECTO trial . However, the definition of RFS and FFP of
these 3 trials was similar to DFS, so we included them. Fourteen
[2021,2324,27,2930,32,34,3738,4042] of the 19 trials had
Jadad scores of 3, and 5 trials [22,26,33,3536] were assessed
with scores of 2. Other detailed information from each trial was
also listed in Table S1.
Total effect of efficacy
Data for DFS were available from all 19 trials [2025,27,29
30,3238,4042] with 8426 events reported. The taxane-based
treatment arm was associated with a clinically and statistically
significant 17% improvement in DFS when compared with the
taxane-free treatment arm (HR = 0.83, 95% CI 0.790.88;
p,0.001; Figure 2) under a random-effect model, and there was
no evidence of significant heterogeneity among individual trials
(p = 0.194, I2 = 21.4%). The taxane-based treatment arm had
lower risk of recurrence in both concurrent and sequential
regimens than the taxane-free treatment arm (p value 0.002 and
0.000, respectively; test for interaction, p = 0.046).
OS was reported in 17 trials [2025,27,2930,32,3435,37
38,4042] of the 19 trials (BIG 298 and NSABP B-27 [33,36] did
not reported OS data), including 25 407 patients who were
recruited in the meta-analysis on the risk of death, resulting in
3803 deaths. The efficacy of taxenes on reducing the risk of death
was presented more both in all trials (HR of overall 0.83, 95% CI
0.770.90) and the trials of different therapy regimens (Figure 3).
We found no evidence of publication bias on either DFS or OS by
the funnel plots and the Begg-Mazumdar test.
In addition, the sensitivity analysis was conducted among 14
trials [2021,2324,27,2930,32,34,3738,4042] after excluding
5 trials [22,26,33,3536] with a low Jadad score (score,3). The
estimated pooled HRs for DFS (HR 0.82, 95% CI 0.760.88) and
OS (HR 0.85, 95% CI 0.780.92) all favoured the arm treated
with taxanes when compared with arm without, and no evidence
of significant heterogeneity was observed among individual trials.
Subgroup analysis of efficacy
Node status. Only 4 trials [20,24,2627] reported HR for
DFS of patients with node-negative BC. The pooled HR of DFS
for these trials was 0.83 (95% CI 0.710.97, p = 0.022; Figure 4),
which corresponds to a 17% reduction in the risk of recurrence
among patients with node-negative BC who received taxanes
(docetaxel). Among the 19 included trials, 10 trials [21,23,29
30,3233,35,37,4142] included only patients with node-positive
disease, and the pooled HR of these trials for DFS also favoured
taxane treatment (HR 0.82, 95% CI 0.770.87; Table 1).
Furthermore, 5 trials [21,24,31,35,37] reported HRs for DFS
separately in the nodes 13 and nodes 4 subgroups. The pooled
HRs also show greater efficacy in the taxane-based treatment arm
of the subgroups with nodes 13 and nodes 4 (HR 0.73, 95% CI
0.590.90, and HR 0.89, 95% CI 0.800.98, respectively;
Drug dosage, schedule, and observation period. The
subgroup analysis of DFS was stratified to trials of different
Figure 2. Taxane-based therapy versus non-taxane-based therapy: meta-analysis of disease-free survival (DFS). NR: not report.
taxane agents (paclitaxel or docetaxel) with different dosage and
schedule (docetaxel 75 mg/m2 or = 100 mg/m2 and paclitaxel
weekly, every 2 weeks, or every 3 weeks) and different observation
periods (median follow-up 5 years or .5 years). Most of the
results showed that the taxane-based treatment arm provided
greater efficacy on improving DFS among patients with early or
operable BC (Table 1). An 18% HR reduction (95% CI 0.76
0.88) was observed for paclitaxel therapy, a 17% HR reduction
(95% CI 0.770.90) was observed for docetaxel therapy, and a
14% HR reduction (95% CI 0.820.90) was observed in the
treatment arm after follow-up of greater than 5 years. Not all
taxane schedules might be equal, and table 1 also indicated that
there was no significantly statistical difference between the
paclitaxel every 2 weeks arm and control arm (HR 0.84, 95%
CI 0.67 to 1.04), although analyses of remaining 2 paclitaxel
schedules (weekly and every 3 weeks) favoured the taxane-based
Others. Subgroup analysis of patients according to their
menopausal status, ER (oestrogen receptor) status, and tumor size
was shown in table 1 and figure 5. Superior efficacy of taxanes
was found in both premenopausal (HR 0.78, 95% CI 0.650.94)
and postmenopausal patients (HR 0.78, 95% CI 0.680.90) after
pooling data from 6 trials [2021,23,31,35,37]. Efficacy data of
adjuvant chemotherapy according to tumer size (,2 cm and
2 cm) was available in 4 trials [20,24,27,35] and 5 trials
[20,24,27,35,38], respectively. The pooled HRs for DFS favoured
the taxane-based treatment arm when compared with the
taxanefree treatment arm both in the tumor size ,2 cm subgroup (HR
0.84, 95% CI 0.720.99) and in the tumor size 2 cm subgroup
(HR 0.87, 95% CI 0.750.99) (Figure 5). Eleven trials [2021,23
24,27,29,31,35,37,4041] reported subgroup results of ER status.
For ER-positive subgroup the pooled HR of 0.83 (95% CI 0.76
0.90) for DFS indicated a 17% reduction in the risk of recurrence
presented in the taxanes-based treatment arm, and for the
ERnegative subgroup the pooled HR of 0.80 (95% CI 0.730.88) for
DFS indicated a 20% reduction in the risk of recurrence
presented among patients received taxanes. However, subgroup
analysis of HER-2 (human epidermal growth factor receptor-2)
status (5 trials [2325,29,37] included) showed no significantly
statistical difference in efficacy of taxanes when comparing the
taxane-based treatment arm with the taxane-free treatment arm
in either HER-2-positive group (HR 0.84, 95% CI 0.681.03) or
HER-2-negative group (HR 0.87, 95% CI 0.731.03; Figure 6).
Although statistical significance was not attained, when
examining the data by HER-2 status, there were similar trends
Figure 3. Taxane-based therapy versus non-taxane-based therapy: meta-analysis of overall survival (OS). NR: not report.
ties (grade 3) was shown in figure 7. The pooled ORs of each
group, stratified according to grade 3 or greater toxicities,
indicated that a significant increase in toxicity associated with
taxane treatment was observed for neutropenia (OR = 1.54,
95%CI 1.102.15), febrile neutropenia (OR = 2.28, 95% CI
1.254.16), fatigue (OR = 2.10, 95% CI 1.373.22), diarrhea
(OR = 2.16, 95% CI 1.323.53), stomatitis (OR = 1.68, 95% CI
1.042.71), and oedema (OR = 6.61, 95%CI 2.1420.49).
However, heterogeneity among trials was found in these analyses,
possibly due to the use of different agents at various dosage and the
use of different control arms. Moreover, subgroup analyses were
performed based on stratification with the 2 types of taxanes. The
results suggested that paclitaxel was associated with statistically
fewer toxicity events when compared with taxane-free therapy in
some toxicities, such as neutropenia (OR = 0.72, 95%CI 0.53
0.98), and febrile neutropenia (OR = 0.51, 95%CI 0.320.79) but
not in other toxicities. However, figure 7 showed that docetaxel
was associated with a significant increase in neutropenia, febrile
neutropenia, leukopenia, stomatitis, oedema, fatigue and/or
asthenia, and diarrhea (Figure 7).
Nineteen randomized, open-label, phase III trials of 30698
women (with 8426 recurrence events and 3803 deaths) were
included to examine the role of taxanes added in adjuvant
chemotherapy for patients with early or operable breast cancer.
The pooled HRs for DFS and OS for all available trials showed
that taxane-based therapy was associated with significant
reduction in the risk of recurrence and death, and the similar
results were observed in the sensitivity analysis. There was no
significant evidence of statistical heterogeneity among individual
trials. This meta-analysis also indicated that taxane-based
adjuvant chemotherapy was more efficacious in improving
DFS and OS when compared with taxane-free therapy. This
result was consistent with results reported in 2 previous reviews
The study conducted by Sparano et al reported that there were
no significant differences in DFS between the paclitaxel-treated
groups and docetaxel-treated groups . This finding was
similar to the results of our study (test for interaction between
docetaxel and paclitaxel, p = 0.824) as well as the meta-analysis
conducted by De Laurentiis et al (test for interaction between
docetaxel and paclitaxel, p = 0.16) . However, Sparano et al
also reported that greater benefits in improving DFS were
observed in the group receiving paclitaxel weekly and the group
receiving docetaxel every 3 weeks when compared with the group
receiving paclitaxel every 3 weeks. The results of our subgroup
analysis according to the paclitaxel schedule showed that patients
receiving paclitaxel weekly and every 3 weeks, but not those
receiving paclitaxel every 2 weeks, demonstrated superior efficacy
to patients in the control arm of the study. We recognize that
comparisons between 2 types of taxanes can be confounded by
drug schedule, as shown in the Sparano trial . Because of
insufficient data, we were unable to make firm conclusion about
the efficacy of various drug schedule (only 4 trials [23,38,4142]
Figure 4. Efficacy of taxanes in subgroup of node-negative, node = 13, node 4: meta-analysis of DFS. NR: not report.
included in paclitaxel every 3 weeks group and 1 trial 
included in paclitaxel weekly group).
The results of subgroup analysis also indicated that there were
significantly gains in DFS in the taxane-based treatment arm,
except for patients with HER-2 status. The pooled HRs of analysis
of among women with either HER-2 positive or HER-2 negative
status showed a favorable trend but no statistical difference
between the 2 treatment arms. However, De Laurentiis et al
reported that the HR for DFS in the HER-2 positive subgroup was
0.51 (95% CI 0.290.87) and in the HER-2 negative subgroup was
0.70 (95% CI 0.550.91) . Only 2 trials [29,37] were included
in their research and the estimated HR may be less reliable.
Nowadays, the predictive value of hormone receptor (particularly
HER-2) in determining taxane responsiveness remains
controversial . Additional 3 trials  were included in our
analysis, and the pooled HR did not confirm the predictive value
of HER-2, however, the point estimate of HRs of most trials
favoured taxanes. Therefore, the presence of HER-2 as a predictor
of taxane responsiveness needs to be further investigated.
A different toxicity profile was confirmed between taxane-based
and taxane-free treatment arms. Drug-related toxicities, such as
neutropenia, febrile neutropenia, and oedema, were reported in
both this study and previous meta-analyses . In our study, the
subgroup analyses of toxicity showed paclitaxel may be associated
with fewer toxicities than docetaxel. However, this conclusion
could not be definitively confirmed because of less available data
on paclitaxel. We need more data to support our result in the
future. Unfortunately, only 3 of these trials provided information
about quality of life (QoL) [20,37,40]. These trials showed no
significant difference in QoL scores between the 2 treatment arms.
Although GEICAM 9805 trial and BCIRG 001 trial [20,37] found
that taxane was associated with a transient reduction in QoL
scores, these scores returned to baseline values afterwards.
The efficacy of taxanes for patients with node-negative breast
cancer, longer observation periods, and varying tumor size was not
reported in the 2 previous meta-analyses. To resolve these
uncertainties, we investigated the efficacy by subgroup analysis
of available trials.
There was insufficient evidence to define the efficacy of taxanes
among the patients with high-risk, node-negative BC, although the
efficacy for node-positive, early-stage breast cancer had been
confirmed. The benefits of adjuvant chemotherapy
(cyclophosphamide combined with methotrexate and 5-fluorouracil) for
node-negative disease was confirmed in 3 trials (NSABP B-13,
B19, B-23) . The GEICAM 9805 trial  randomly assigned
1060 patients with high-risk, axillary-nod-negative BC to
TAC(docetaxel, doxorubicin, and cyclophosphamide) arm or FAC
(fluorouracil, doxorubicin, and cyclophosphamide) arm, and the
trial reported that the hazard ratio for DFS significantly favoured
the TAC arm (HR 0.68, 95% CI 0.490.93, p = 0.01). However, 4
Test of Heterogeneity
Figure 5. Efficacy of taxanes in subgroups of tumor size ,2 cm, tumor size 2 cm: meta-analysis of DFS.
trials [24,2627,36] reported the efficacy of taxane (docetaxel) for
patients with node-negative BC in subgroup analysis. The results
of these 4 trials did not show a significant difference between the
docetaxel and control arms (the NSABP B-27 trial  did not
report exact data of HR for DFS in subgroup analysis). Patients in
the GEICAM 9805 trial received docetaxel with 6 cycles, and
patients in the other 4 trials received docetaxel with 4 cycles. More
therapy cycles of docetaxel may be much more beneficial for
nodenegative BC. Nevertheless, our study did not compare different
therapy cycles because of the limited availability of trials. Data
concerning DFS from 4 available trials [20,24,2627] were pooled
(excluded NSABP B-27), and the result (HR 0.83 95% CI 0.71
0.97) significant favored the docetaxel regimen. Therefore, this
subgroup analysis provided evidence that docetaxel was useful in
improving DFS among patients with high-risk, node-negative BC,
which was consistent with the result of the GEICAM 9805 trial.
Trials included in this study were observed with various median
follow-up periods. Our aim was to determine whether
taxanebased therapy could be efficacious against BC during longer
observation periods. The results demonstrated that the benefits of
taxanes were still observed during longer follow-up period (HR
0.86, 95% CI 0.820.90). However, the results in 2 two trials [22
23] (Anglo-Celtic trial and the Boccardo et al. trial with median
follow-up of 99 and 102 months, respectively) did not show
significant efficacy of taxanes in improving DFS (HR 0.79, 95%
CI 0.561.12; HR 1.16, 95% CI 0.791.75; for these two trials
respectively). These results differed from results of our
metaanalysis, possibly due to the small sample size of these 2 trials (only
363 patients recruited in Anglo-Celtic trial and 244 patients in
Boccardo et al trial). Our study provided stronger evidence
demonstrating the efficacy of taxanes for early or operable BC
under longer observation periods. Moreover, RCTs which recruit
larger population with longer follow-up time will be required to
confirm the efficacy of the agent.
The patients included in the ECTO trial  all had tumor
size greater than 2 cm, with efficacy results showing that the
paclitaxel produced significant benefit for this group of patients.
For the remaining 4 trials [20,24,27,35], the results did not show
any significantly statistical difference between 2 arms in subgroup
analysis of tumor size (either tumor size ,2 cm or 2 cm).
However, the estimated HRs using the data of these 5 trials
showed taxane-based therapy was statistically superior in
reducing the risk of cancer recurrence among patients with both
tumor size ,2 cm and 2 cm compared with taxane-free
therapy (Figure 5). Consequently, the pooled analysis confirmed
the efficacy of taxanes and was consistent with the results of the
Our meta-analysis also has several potential limitations. First,
our study was based on abstracted data and not on individual
patient data (IPD), which may not provide robust estimation for
the association. Second, the characteristics of the included trials
were varied in the follow-up observation period, therapy regimen,
agents and dosage. Third, there may be several trials with
available data that were ongoing or unpublished at the time of the
writing of this manuscript that were not included in this
metaanalysis, in addition to the 19 trials included in this study.
Consequently, publication bias may be unavoidable in this
metaanalysis. However, the results form the funnel plots and the
BeggMazumdar test did not indicate significant publication bias.
Despite the limitations of our research, the results strongly suggest
that adjuvant chemotherapy that includs taxanes provides a significant
advantage in improving both DFS and OS among patients with early
or operable BC compared with therapy without taxanes. Moreover,
the subgroup analysis concerning node status also demonstrated that
docetaxel-based therapy is superior to docetaxel-free therapy, for high
risk node-negative BC, in reducing the risk of cancer recurrence.
Additional well-designed RCTs with varying drug schedules for both
operable and node-negative BC are warranted to further evaluate
these conclusions. The benefit of taxanes should be balanced against
their toxicity, and additional data on QoL should be provided in
further analysis. Physicians should take these adverse drug events into
consideration and interpret the results carefully and comprehensively
in clinical practice.
Baseline characteristics for included trials.
We all thank Zhi-Chao Jin for his generous assistance with this study.
Editorial support in the final preparation of the manuscript was provided
by Editage Company.
Conceived and designed the experiments: JH YYQ HL. Performed the
experiments: YYQ XJG HL XFY. Analyzed the data: YYQ YHZ.
Contributed reagents/materials/analysis tools: XJZ. Wrote the paper:
YYQ XFY XW WQ CW JL.
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