A careful reassessment of anthracycline use in curable breast cancer

Affiliations

¹ Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA. shurvitz@mednet.ucla.edu.
² Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA.
³ Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁴ University of Southern California, Los Angeles, CA, USA.
⁵ Stanford Comprehensive Cancer Institute, Palo Alto, CA, USA.
⁶ Department of Medical Oncology, St. Vincent's University Hospital, Dublin, Ireland.
⁷ Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
⁸ Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.

PMID: 34625570
PMCID: PMC8501074
DOI: 10.1038/s41523-021-00342-5

Review

A careful reassessment of anthracycline use in curable breast cancer

Sara Alsterlind Hurvitz et al. NPJ Breast Cancer. 2021.

. 2021 Oct 8;7(1):134.

doi: 10.1038/s41523-021-00342-5.

Authors

Affiliations

¹ Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA. shurvitz@mednet.ucla.edu.
² Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA.
³ Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁴ University of Southern California, Los Angeles, CA, USA.
⁵ Stanford Comprehensive Cancer Institute, Palo Alto, CA, USA.
⁶ Department of Medical Oncology, St. Vincent's University Hospital, Dublin, Ireland.
⁷ Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
⁸ Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.

PMID: 34625570
PMCID: PMC8501074
DOI: 10.1038/s41523-021-00342-5

Abstract

It has been over three decades since anthracyclines took their place as the standard chemotherapy backbone for breast cancer in the curative setting. Though the efficacy of anthracycline chemotherapy is not debatable, potentially life-threatening and long-term risks accompany this class of agents, leading some to question their widespread use, especially when newer agents with improved therapeutic indices have become available. Critically assessing when to incorporate an anthracycline is made more relevant in an era where molecular classification is enabling not only the development of biologically targeted therapeutics but also is improving the ability to better select those who would benefit from cytotoxic agents. This comprehensive analysis will present the problem of overtreatment in early-stage breast cancer, review evidence supporting the use of anthracyclines in the pre-taxane era, analyze comparative trials evaluating taxanes with or without anthracyclines in biologically unselected and selected patient populations, and explore published work aimed at defining anthracycline-sensitive tumor types.

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Conflict of interest statement

S.A.H.: Contracted research paid to institution: Ambrx, Amgen, AstraZeneca, Arvinas, Bayer, Cytomx, Daiichi Sankyo, Dignitana, Genentech/Roche, Gilead, GSK, Immunomedics, Lilly, Macrogenics, Novartis, Pfizer, OBI Pharma, Pieris, PUMA, Radius, Samumed, Sanofi, Seattle Genetics/Seagen, Zymeworks, Phoenix Molecular Designs, Ltd. Travel expenses: Lilly. Uncompensated consulting: 4DPharma, Ambrx, Amgen, Artios, Arvinas, Daiichi Sankyo, Dantari, Genentech/Roche, Immunomedics, Macrogenics, Lilly, Novartis, Pieris, Pyxis, Seagen, N.P.M.: Research funding from Novartis, Daiichi Sankyo, and Dizal, advisory board honorarium from Novartis, Daiichi Sankyo, Biotheranostics, and Genomic Health, consulting honorarium from Novartis and Daiichi Sankyo, travel accommodation from TRIO, Daiichi Sankyo, and Roche, as well as speaking honorarium from Novartis. A.B.: Consulting: Immunomedics, Pfizer, Novartis, Genentech/Roche, Merck, Radius Health, Spectrum Pharma, Taiho Pharma, Biothernostics Inc., Sanofi, Daichi Pharma, Puma; personal fees from Biothernostics Inc., Pfizer, Novartis, Genentech/Roche, Merck, Radius Health, Immunomedics, Spectrum Pharma, Taiho Pharma, Sanofi, Daiichi Pharma, Puma; grants paid to the institution from Genentech/Roche, Novartis, Pfizer, Merck, Sanofi, Radius Health, Immunomedics, Mersana, Innocrin, Biothernostics Inc. M.F.P.: Contracted research: Cepheid; Eli Lilly & Company; Novartis Pharmaceuticals; F. Hoffmann-La Roche Ltd; Puma; Consulting or advisory role with honoraria: AstraZeneca; Biocartis SA; Cepheid, Eli Lilly & Company, USA, LLC; Merck & Co; Puma Biotechnology; Zymeworks Inc. Expert testimony: Amgen, Inc. Private equity: TORL Biotherapeutics, LLC. M.P.: Honoraria: Roche/Genentech; Sponsored Research: Stanford Cancer Institute, Parker Institute for Cancer Immunotherapy, Pfizer, G1 Therapeutics, Zymeworks, Daiichi Sankyo, Odonate, Bolt Biotheranostics. J.P.C.: Research funding (to institution): Eisai, Puma Biotechnology, Roche, Boehringer Ingelheim; Employment: OncoMark, Ltd.; Honoraria: Eisai, Puma Biotechnology; MSD Oncology, Pfizer, G1 Therapeutics; Novartis; Speaker’s Bureau: Boehringer Ingelheim, Genomic Health, Roche, Pfizer; Shares: OncoMark Ltd; Travel and accommodation expenses: Pfizer, MSD, Abbvie, Astrazeneca, Novartis. P.A.F.: Research funding to institution: Biontech, Cepheid. Consulting fees: Novartis, Pfizer, Daiichi Sankyo, AstraZeneca, Eisai, Merck Sharp & Dohme, Lilly, Pierre Fabre, SeaGen, Roche, Hexal, Agendia. B.E.: Research funding to institution: AstraZeneca, MSD, NanoString Technologies, Novartis, Oncology Venture, Pfizer, Roche, and Samsung. E.H.Y.: research funding from CSL Behring. J.A.G.: no conflicts to report. D.J.S.: Advisory board membership: Biomarin; Consultancy: Lilly, Novartis, Pfizer, Seagen; Equity ownership: Amgen, Biomarin, Merck, Sharp & Dohme, Pfizer, Seagen, Vertex; Honorarium: Novartis; Research funding paid to institution: Novartis, Pfizer, Seagen; Speaker’s Bureau: Novartis; Travel expenses: Biomarin, Novartis, Pfizer.

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A careful reassessment of anthracycline use in curable breast cancer

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A careful reassessment of anthracycline use in curable breast cancer

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