Efficacy of taxanes as adjuvant treatment of breast cancer: a review and meta-analysis of randomised clinical trials.

OBJECTIVES: To evaluate the magnitude of benefit obtained by taxanes as adjuvant treatment of breast cancer and to assess the best method for their administration. MATERIAL AND METHODS: We performed a systematic search of phase III randomised clinical trials that included patients with non-metastatic breast cancer in whom comparisons were chemotherapy (CT) containing a taxane (docetaxel or paclitaxel) vs. CT without taxanes (first-generation trials), or CT with taxane in both treatment arms (second-generation trials), administered after surgery. The parameters of efficacy evaluated were disease-free survival (DFS) and overall survival (OS). The data obtained in the first-generation trials (number of relapses and deaths) were submitted to a meta-analysis. The odds ratio (OR) combined with DerSimonian and Laird (OR DL) and 95% confidence interval (95% CI) were calculated. Further, an analysis was performed of those trials that included only patients with nodal involvement (N+). In both cases, the results were also analysed as a function of the taxane used, and with indirect comparisons between the two. The second-generation trials were analysed to assess the optimum method of administration. RESULTS: A total of 17 trials were selected for the meta-analysis (30,672 patients). The OR DL was 0.82 (95%CI: 0.76-0.88) for DFS and 0.83 (95% CI: 0.75-0.91) for OS. In N+ patients the results were 0.80 (95% CI: 0.74-0.86) and 0.79 (95% CI: 0.69-0.89), respectively. Docetaxel and paclitaxel significantly increased the DFS and OS. In our indirect comparison, the benefit of docetaxel on OS was significantly superior to that obtained with paclitaxel in N+ patients (OR: 0.79; 95% CI: 0.63-0.98). CONCLUSIONS: The administration of adjuvant CT-based taxanes reduces the risk of relapse and death. This reduction is superior in clinical trials that included only N+ patients. With the available evidence, it would appear that the best method of administering paclitaxel is weekly and for docetaxel tri-weekly.

[Knowledge and gaps on the role of nutrition and physical activity on the onset of childhood obesity]. / Conocimientos y lagunas sobre la implicación de la nutrición y la actividad física en el desarrollo de la obesidad infantil y juvenil.

Childhood and adolescent obesity has increased at alarming rates over the last few years, due to the concurrence of a variety of genetic and environmental factors. The aim of this study was to conduct a review of published studies in the past ten years evaluating the development of childhood obesity in relation to energy and macronutrients intake, their distribution throughout the day and physical activity patterns. 31 articles dealing with this subject were selected. Results obtained appear to indicate that reducing dietary fat and increasing dietary carbohydrate intakes along with consuming an adequate breakfast and carrying out leisure time physical activity on a regular basis act as determining factors to prevent childhood and adolescent obesity, even though the strength of the evidence from these studies is low. It should be a priority to conduct follow-up studies with comparable methodologies in Mediterranean countries, in order to establish parameters for the prevention and control of childhood and adolescent obesity.