Anthracyclines for Early-Stage HER2-Positive Breast Cancer

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The use of anthracyclines in the adjuvant treatment of patients with early-stage HER2-positive breast cancer is an area that has posed many questions in recent years. These concerns have prompted some physicians to consider abandoning the use of anthracyclines, due to recent clinical trials and the toxicity profile, explains Debu Tripathy, MD.

Linda T. Vahdat, MD, notes that anthracyclines have been a cornerstone in the treatment of breast cancer and that she would not abandon their use in patients with HER2-positive disease. William J. Gradishar, MD, believes that not enough data is available to accurately make a decision regarding anthracyclines.

Current trials have demonstrated that the anthracycline-based chemotherapy regimen ACTH (Adriamycin, Carboplatin, Taxotere, Herceptin) is roughly equivalent to the non-anthracycline regimen TCH (Taxotere, Carboplatin, Herceptin). Christy A. Russell, MD, explains that the BCIRG trial indirectly showed that the TCH regimen was approximately 3% inferior to ACTH. However, both treatment regimens were roughly the same in women with four or more positive lymph nodes.

When considering toxicity, Joyce A. O'Shaughnessy, MD, notes that patient selection is key for the consideration of an anthracycline-containing regimen. It is important to monitor for cardiac risk factors such as hypertension or higher baseline left ventricular ejection fractions. Stressing the importance of monitoring, Gradishar adds that cardiac toxicity is largely reversible if treated early.