{"entity":{"id":"paper-ebctcg-polychemotherapy-regimens-meta-analysis-lancet-2012","kind":"paper","name":"Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials","aka":[],"tldr":"The Oxford overview of 123 trials and 100,000 women showing that anthracycline and taxane chemotherapy cuts breast cancer deaths by about a third, largely regardless of age, nodes, size, grade or hormone receptor status; it is the foundation triple-negative chemotherapy rests on.","summary":"The Early Breast Cancer Trialists' Collaborative Group performed individual patient data meta-analyses of trials comparing taxane-plus-anthracycline regimens with the same or more non-taxane chemotherapy (44,000 women), one anthracycline regimen with another (7,000) or with CMF (18,000), and polychemotherapy with none (32,000). Adding four separate taxane cycles to a fixed anthracycline regimen reduced breast cancer mortality (rate ratio 0.86, standard error 0.04, 2p=0.0005); when controls received extra non-taxane cycles instead there was no significant difference (0.94). Standard 4AC and standard CMF were equivalent (0.98), but higher-cumulative-dose anthracycline regimens (CAF, CEF) beat CMF (0.78, 2p=0.0004). Against no chemotherapy, CAF (0.64), standard 4AC (0.78) and CMF (0.76) all reduced mortality. Proportional reductions were little affected by age, nodal status, tumour diameter, differentiation, oestrogen receptor status or tamoxifen use; some taxane-plus-anthracycline or higher-dose anthracycline regimens reduced breast cancer mortality by about one third, and ten-year overall mortality differences paralleled this despite toxicity.","asOf":"2026-09-24","links":[{"label":"Lancet 2012","url":"https://doi.org/10.1016/S0140-6736(11)61625-5"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/22152853/"}],"tags":["tnbc-evidence"],"related":[],"cancers":["tnbc","breast-hr-positive"],"sections":[],"technologies":[],"targets":[],"drugs":["doxorubicin","cyclophosphamide","paclitaxel"],"companies":[],"institutions":["cruk"],"pathways":[],"terms":["anthracycline","taxane","neoadjuvant-adjuvant"],"trials":["scarlet-s2212"],"people":["richard-peto"],"bottlenecks":[],"keyPapers":[],"journals":["lancet"],"dependsOn":[],"notes":[],"journal":"The Lancet","year":2012,"doi":"10.1016/S0140-6736(11)61625-5","pmid":"22152853","authors":"Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Peto R, Davies C, et al.","paperType":"meta-analysis","findings":["Adding a taxane to a fixed anthracycline regimen: breast cancer mortality rate ratio 0.86 (SE 0.04, 2p=0.0005).","Higher-dose anthracycline regimens (CAF, CEF) vs CMF: 0.78 (2p=0.0004); CAF vs no chemotherapy 0.64.","About one-third reduction in breast cancer mortality, largely independent of age, nodes, size, grade or oestrogen receptor status."],"whatItMeans":"Chemotherapy works in receptor-negative disease at least as well as in receptor-positive disease in proportional terms, and because triple-negative absolute risk is high the absolute gain is large; this is why anthracycline and taxane backbone survived into KEYNOTE-522 and why SCARLET now asks whether the anthracycline can go.","caveats":["Trials predate receptor-defined subgroups; triple-negative status was not recorded.","The overview cannot say which patients need which regimen, a gap it names itself."],"changedPractice":true,"participants":100000},"route":"/key-papers/paper-ebctcg-polychemotherapy-regimens-meta-analysis-lancet-2012/","neighbours":{"cancer":[{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"tnbc","kind":"cancer","name":"Triple-negative breast cancer (TNBC)","route":"/cancers/tnbc/"}],"drug":[{"id":"cyclophosphamide","kind":"drug","name":"Cyclophosphamide","route":"/drugs/cyclophosphamide/"},{"id":"doxorubicin","kind":"drug","name":"Doxorubicin","route":"/drugs/doxorubicin/"},{"id":"paclitaxel","kind":"drug","name":"Paclitaxel / nab-paclitaxel","route":"/drugs/paclitaxel/"}],"institution":[{"id":"cruk","kind":"institution","name":"Cancer Research UK","route":"/institutions/cruk/"}],"term":[{"id":"anthracycline","kind":"term","name":"Anthracyclines (doxorubicin, epirubicin)","route":"/terms/anthracycline/"},{"id":"neoadjuvant-adjuvant","kind":"term","name":"Neoadjuvant / adjuvant / perioperative","route":"/terms/neoadjuvant-adjuvant/"},{"id":"taxane","kind":"term","name":"Taxanes (paclitaxel, docetaxel, nab-paclitaxel)","route":"/terms/taxane/"}],"trial":[{"id":"scarlet-s2212","kind":"trial","name":"SCARLET (SWOG S2212)","route":"/trials/scarlet-s2212/"}],"person":[{"id":"richard-peto","kind":"person","name":"Sir Richard Peto","route":"/people/richard-peto/"}],"journal":[{"id":"lancet","kind":"journal","name":"The Lancet","route":"/journals/lancet/"}],"roadmap":[{"id":"tnbc-roadmap","kind":"roadmap","name":"Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem","route":"/roadmaps/tnbc-roadmap/"}]}}