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Anthracyclines in Early-Stage Breast Cancer: Is It the End of an Era?

Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada

Key Words. Adjuvant chemotherapy • Anthracyclines • Breast Neoplasm • Cardiotoxicity • Leukemogenicity

Correspondence: Correspondence: Sunil Verma, B.Sc., M.D., M.S.Ed., F.R.C.P.C., T-Wing, 2nd Floor, Sunnybrook Odette Cancer Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada, M2N3E6. Telephone: 416-480-5248; Fax: 416-480-6002; e-mail: sunil.verma{at}sunnybrook.ca

Received March 24, 2008; accepted for publication May 23, 2009.

Disclosures: Danny Robson: None. Sunil Verma: Honoraria: AstraZeneca, Sanofi-Aventis, Pfizer; Research funding/contracted research: AstraZeneca, Sanofi-Aventis.

Anthracycline regimens have been the mainstay of adjuvant care in breast cancer for >20 years. A growing body of clinical experience has uncovered an unacceptable rate of significant cardiac and leukomogenic toxicities. A systematic review of the literature was performed highlighting anthracycline- and nonanthracycline-based adjuvant regimens. The published data suggest that nonanthracycline alternatives are less toxic than anthracycline-containing regimens and equally, if not more, efficacious. Molecular predictors, such as human epidermal growth factor receptor 2 and topoisomerase II , are further refining the optimal role of anthracyclines. With these new advances, the current role of anthracycline-based chemotherapy in early-stage breast cancer demands re-examination.

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				K. I. Pritchard Commentary: Anthracyclines in Early-Stage Breast Cancer: Is It the End of an Era? Oncologist, October 1, 2009; 14(10): 959 - 962. [Full Text] [PDF]