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Breast Cancer

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: 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; first published online in THE ONCOLOGIST Express on June 26, 2009.

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

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors or independent peer reviewers.

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]