[Anthracyclines in the adjuvant treatment of breast carcinoma: thirty years later]

Abstract

In the last decades, the use of adjuvant systemic treatment for early breast cancer has increased progressively, and has contributed to the decrease in breast cancer mortality in the U.S. and in some European countries, although a raising in the disease incidence has been observed. Traditionally, the most extensively used chemotherapy regimens have been those containing an anthracycline, namely doxorubicin or epirubicin. Due to its more favorable toxic profile, epirubicin is preferable to doxorubicin and, in fact, it has been used in the majority of adjuvant studies carried out in Europe. The use of epirubicin in the U.S. is increasing since 1999, when it was approved by the Food and Drug Administration. Anthracycline-based regimens are superior to CMF-like combinations. The recent development of anthracycline-taxane regimens has shown further benefit in disease-free survival and, in some trials, in overall survival. In patients with HER2-positive tumors, trastuzumab has dramatically improved therapeutic results when added to standard adjuvant treatment. It is likely that new technologies (i.e. genomics and proteomics), as well as the appropriate use of translational research along with the development of new molecularly targeted agents, will lead to even greater achievements in the management of early breast cancer. Nevertheless, it should be considered that at present time chemotherapy is generally needed either alone or in combination with hormonal or biologic agents. In particular, the role of anthracyclines remains unchanged because they have contributed significantly to the improvement of survival of patients with breast carcinoma.