Is Methotrexate (CMF) more effective in reducing tumors in early stages of breast cancer than is Paclitaxel?
The narrative bibliography is divided into four main sections. These sections include introduction, methods, discussion and conclusion. The narrative bibliography reflection on several references used in the research paper to determine between which drug is more efficient that the other between paclitaxel and methotrexate. The bibliography has eight sources and the entire narrative bibliography is divided into four main sections including introduction, methods, discussion and conclusion.
Keywords: Paclitaxel, Methotrexate, Breast Cancer, Chemotherapy, Anthracyclines, Taxanes
Methotrexate and paclitaxel are very good medications for breast cancer. These medications are, however, different in their actions on medications of breast cancer. The drugs are from different classes but they differ in their mechanism of actions. Methotrexate and paclitaxel are both quite effective in the management of breast cancer. In combination, the differences change in the efficacy of the drugs. It is notable that when used in combination, paclitaxel is not preferred due to its adverse effects. Methotrexate does not have many side effects, but it does not have the same level of efficacy. This narrative bibliography discusses the references used in a research paper to determine between paclitaxel and methotrexate to see which is has more potency.
There are several databases that were used by the author in order to come up with the selected bibliography. It is notable that author knew how to get credible materials to back up his research. The use of professional journal databases is the best way to have materials that are peer reviewed and which have met satisfactory scrutiny for their benefits in a research. The research question is taken into consideration when the search for the material is conducted. It determines the choice of keywords to be used in the search.
The author has selected all the journal articles from the same professional medical journal database. Pubmed is the database selected. The choice of search words was also professionally done based on the research question. Two of the articles were selected based on the search words “paclitaxel early breast cancer” hence giving articles based on paclitaxel and their use in early breast cancer management. There were several articles relevant to the topic but only two of the articles were selected which includes result number two “Balancing activity and tolerability of neoadjuvant paclitaxel- and docetaxel-based chemotherapy for HER2-positive early stage breast cancer: sensitivity analysis of randomized trials” and result number nine “paclitaxel early breast cancer”.
The next search words used were “CMF early breast cancer” which also yielded a host of results. From those results, three articles were selected for use in the bibliography of the research paper. They included search result number eight “Withdrawn: Multi-agent chemotherapy for early breast cancer”, search result number four “Comparative benefit from small tumor size and adjuvant chemotherapy: clues for explaining breast cancer mortality decline”, and search result number two “Dose-dense sequential adjuvant chemotherapy followed, as indicated, by trastuzumab for one year in patients with early breast cancer: first report at 5-year median follow-up of a Hellenic Cooperative Oncology Group randomized phase III trial”.
Once again, the author changed the search words of the topic to enhance access to more credible information. The new search words used for the selection were “early breast cancer Paclitaxel”. These search words were only a minor modification from the ones used in the first search. However, even the minor modification brought a little change in the search process and new sources were arrived at. The selection led to selection of one article which was the first search result, “Adjuvant chemotherapy for early female breast cancer: a systematic review of the evidence for the 2014 Cancer Care Ontario systemic therapy guideline.”
Although the author of this article understands the question of discussion and has great skills in research writing, he is also not very good with keywords for searching resources to be used in the article. For instance, the research question compares paclitaxel with methotrexate. It would have been logical for him to search for materials through search words with the two words together so that he can get materials with the two being compared for efficiency, efficacy or any other qualities. Articles with the two main topics being discussed together is beneficial because it helps the author in offering a clear discussion that offers to the reader information of the similarities of the two drugs as opposed to when the author has to discuss each drug individually since it is more demanding and hard to explain. Choosing the right keywords also helps the author in accessing more credible information which appears at the top page of the search results saving time for the research. However, it is important to note that although the keywords used in the research were poor, the author also was keen to ensure that the he did not select the first items on the search results but went over the search results keenly to identify those that gave the most relevant information about his topic. In fact, from the selection, the author was able to find articles which had both methotrexate and paclitaxel discussed together, which was beneficial for the eventual literature analysis of that topic.
Paclitaxel and Docetaxel are two drugs in the same class called taxanes. The author has discussed the combination of these two taxanes in a therapy for management of the early signs of breast cancer. Paclitaxel is seen as a very superior drug in dealing with early signs of breast cancer and it has great impact in lowering neutropenia (Carbognin et al, 2015). However, paclitaxel has a higher toxicity. The information is beneficial when reviewing the combination of paclitaxel with methotrexate as other elements of the drug can be analyzed to identify its toxicity levels compared to those of methotrexate. However, although this reference has been selected to discuss the effects of combination therapy and to determine whether paclitaxel is less effective in management of early signs of breast cancer, it does not have great significance in the research for two main reasons (Carbognin et al, 2015). First, the drug has been compared with another drug of its own kind, and, therefore, the toxicity levels of paclitaxel are not compared to those of methotrexate, but to those of its derivative. Secondly, the mechanism of action of paclitaxel is not known, and, hence it would be hard to explain its interaction with the breast cancer cells. In short, no comparison has been made with methotrexate. However, it is clear from the study that paclitaxel has a degree of effect on early breast cancer cells, and it could be useful in the management of the cancer.
From the information given by the comparison of the two taxanes, a foundation is laid on the potent of paclitaxel having an impact on early breast cancer cells. That information would be very important if it was also found that methotrexate also has a significant impact on early management of breast cancer as then the efficiency of the two could be discussed, either in combination or independently (Choi et al, 2015). A reference is made on the impact of paclitaxel on the microengineering of pathophysiology of the breast cancer cell. It is identified that to fight cancer effectively, paclitaxel interferes with the micro-environment of the breast cancer cells. The introduction of paclitaxel in the early cells of breast cancer showed a reduction in the cell proliferation as compared to those cells that did not have paclitaxel introduced into their internal environment. This discovery is of market importance in oncology, and it lays foundation in responding to the research question of the topic. The only catch is that the diagnosis of the cancer must be done early. It is very unfortunate that in many cases cancer is diagnosed when it is already too late, and, therefore, it is necessary that research be conducted on improvement of cancer diagnosis for benefits of paclitaxel to be realized in patients. The article, however, gives great insight and prepares the scholar on expectations required in the analysis of methotrexate.
Early Breast Cancer Trialists’ Collaborative Group, in their article offer a detailed description of the action of methotrexate when used in polychemotherapy. The drug is used in combination with Anthracycline-containing regimens showing that when used in combination with such drugs, the survival rate of patient is improved up to 72% from the 69% that is there before a combination of chemotherapy is introduced (Clarke, 2008). By comparing the outcome with those of paclitaxel seen earlier, it is clear that the two drugs have great benefits they can render to each other when used in combination. It is also clear that when used individually, methotrexate seems to have more benefits to the patient. A combination of Paclitaxel and CMF, however, shows fewer efficacies as opposed to when each drug is combined with other chemotherapy regimens. This is important because it gives a certain insight into the two drugs. First, even though the two drugs have benefits in management of breast cancer, combining them may give fewer benefits. Secondly, paclitaxel is beneficial in early breast cancer cells as opposed to methotrexate, by CMF acts better when in all types of cancer cells regardless of the proliferation. It has been identified that, according to (Demicheli & Ambrogi, 2014) that CMF is also quite beneficial in early breast cancer management especially for small tumors. This bit of information helps in comparing the outcomes of CMF and paclitaxel.
A combination in which anthracyclines and taxanes such as paclitaxel are used show that paclitaxel is more potent than CMF when used in such combination because most of its toxicities are overshadowed by the benefits (Gandi et al, 2014). However, overall, CMF would be the best choice even in such combinations because of the fact that it does not have much side effects compared to paclitaxel (Schmidt, 2014). It is worth noting that side effects are undesirable as sometimes they may even be more dangerous than the prognosis of the cancer.
The essence of the narrative bibliography was to review the list of bibliography from the search process to their use in scholarly determination. The research question seeks to determine which drug between the methotrexate and paclitaxel is more beneficial in treatment and management of breast cancer it its early stage. The review of the articles used show different elements of the two drugs which help in coming up with the conclusion. It is clear from the analysis of these resources that methotrexate is better than paclitaxel because it has less side effects as compared to paclitaxel. The resources selected for the topic were overall good for the topic, and they can be used to form the basis of the research effectively.
- Carbognin L, Sperduti I, Nortilli R, Brunelli M, Vicentini C, Pellini F, et al. Balancing activity and tolerability of neoadjuvant paclitaxel- and docetaxel-based chemotherapy for HER2-positive early stage breast cancer: sensitivity analysis of randomized trials. Cancer Treat Rev. 2015 Mar;41(3):262-70. doi: 10.1016/j.ctrv.2015.02.003. Epub 2015 Feb 9.
- Choi Y, Hyun E, Seo J, Blundell C, Kim HC, Lee E, et al.microengineered pathophysiological model of early-stage breast cancer. Lab Chip. 2015 Aug 21;15(16):3350-7. doi: 10.1039/c5lc00514k.
- Clarke MJ. WITHDRAWN: Multi-agent chemotherapy for early breast cancer. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD000487. doi: 10.1002/14651858.CD000487.pub2.
- Demicheli R, Ambrogi F. Comparative benefit from small tumour size and adjuvant chemotherapy: clues for explaining breast cancer mortality decline. BMC Cancer. 2014 Sep 24;14:702. doi: 10.1186/1471-2407-14-702.
- Fountzilas G, Dafni U, Papadimitriou C, Timotheadou E, Gogas H,et al.. Dose-dense sequential adjuvant chemotherapy followed, as indicated, by trastuzumab for one year in patients with early breast cancer: first report at 5-year median follow-up of a Hellenic Cooperative Oncology Group randomized phase III trial. BMC Cancer. 2014 Jul 15;14:515. doi: 10.1186/1471-2407-14-515.
- Gandhi S, Fletcher GG, Eisen A, Mates M, Freedman OC, Dent SF,et al Adjuvant chemotherapy for early female breast cancer: a systematic review of the evidence for the 2014 Cancer Care Ontario systemic therapy guideline. Curr Oncol. 2015 Mar;22(Suppl 1):S82-94. doi: 10.3747/co.22.2321.
- Schmidt M. Chemotherapy in early breast cancer: when, how and which one? Breast Care (Basel). 2014 Jul;9(3):154-60. doi: 10.1159/000363755.