taxanes in metastatic breast cancer - Alberta Health Services

CLINICAL PRACTICE GUIDELINE BR-001
m. One phase III trial
. 47 was 41.7 months for the triplet arm but had not yet been reached in the doublet ar
compared paclitaxel/trastuzumab + carboplatin with paclitaxel/trastuzumab Median progression free
survival was longer with the triplet arm (10.7 versus 7.1 months), and overall response rate higher (52
versus 36%). No difference was found for median
overall survival (35.7 versus 32.2 months).
A Cochrane systematic
review examining the efficacy of trastuzumab + other drug therapy, or trastuzumab
alone in HER2 positive metastatic breast cancer is awaited.
Summary statement
The current panel largely considered the relevant trials of taxane regimens plus/minus trastuzumab in
metastatic breast cancer where HER2 is over-expressed to create a de novo recommendation.
Limitations
The major limitation encountered in using the ADATPE process was that the two evidence-based
guidelines selected, NICE ly. A significant amount
some instances, this
7 and CCO 6 were released in 2001 and 2003 respective
of more current evidence was reviewed to ensure up-to-date recommendations. In
required de novo recommendation development.
Implications for Alberta Health Services
Most regimens recommended
or listed as options in this guideline were available through the Alberta
Health Services – Cancer Care Drug Benefit Program as of July 2007 when the draft report was being
sent for external review. Docetaxel and gemcitabine would require
a formulary addition request to the
Provincial Pharmacy and Therapeutics Committee
(which takes into account cost implications). Nabpaclitaxel
had recently been added to the Drug Benefit Program. In contrast to this guideline, criteria for
use of nab-paclitaxel in the Drug Benefit Program includes: “demonstrated intolerance to solvent-based
taxanes.”
IMPLEMENTATION STRATEGY
• Present the guideline in the tumour team meetings and weekly rounds.
• Post the
guideline on the Alberta Health Services website.
EVALUATION STRATEGY
A formal review will be conducted in 2010, however if new evidence is brought forward before that time,
the guideline will be changed accordingly.
DECLARATION OF CONFLICT OF INTEREST
None of the authors of this guideline had any conflict of interest related to evidence or recommendations in
this guideline.