The role of taxanes in the treatment of breast cancer

Among the novel chemotherapeutic agents introduced in the last decade, the taxanes have emerged as the most powerful group of compounds, and results available so far confirm that they will be remembered in the future as the breast cancer chemotherapy of the 1990s. Two taxanes are available (paclitaxel and docetaxel) and they share some characteristics, although they do have some significant differences both in terms of their preclinical profile and, most importantly, their clinical characteristics. There are three main clinical differences: different efficacy–toxicity ratio in relation to dose and schedule; different integrability in anthracycline- and taxane-containing regimens, secondary to differences in pharmacokinetic interactions with anthracyclines; and different level of synergism between each taxane and trastuzumab. In clinical practice, the taxanes are now standard therapy in metastatic breast cancer. Their role as monochemotherapy or in combination with anthracyclines in advanced breast cancer has suggested their potential therapeutic impact in the treatment of patients with early breast cancer. Recent results in the adjuvant setting show that taxanes, used either in combination or in sequential therapy, possess the capability to induce significant improvements, in particular in terms of survival; thus confirming the positive impact of taxanes on the natural history of breast cancer. However, further results of all completed or ongoing Phase III trials in the early setting will help define the optimal use of taxanes and maximise the induced benefits for breast cancer patients.