Review
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World J Clin Oncol. Aug 10, 2014; 5(3): 529-538
Published online Aug 10, 2014. doi: 10.5306/wjco.v5.i3.529
Adjuvant chemotherapy in breast cancer: To use or not to use, the anthracyclines
Jennifer A Crozier, Abhisek Swaika, Alvaro Moreno-Aspitia
Jennifer A Crozier, Abhisek Swaika, Alvaro Moreno-Aspitia, Department of Hematology and Oncology, Mayo Clinic, Jacksonville, FL 32224 , United States
Author contributions: All authors contributed to this paper.
Correspondence to: Alvaro Moreno-Aspitia, MD, Associate Professor of Medicine, Department of Hematology and Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, United States. morenoaspitia.alvaro@mayo.edu
Telephone: +1-904-9530118 Fax: +1-904-9530118
Received: March 31, 2014
Revised: May 14, 2014
Accepted: June 10, 2014
Published online: August 10, 2014
Processing time: 122 Days and 18.1 Hours
Abstract

Breast cancer continues to be one of the leading causes of cancer mortality in the world. The treatment generally involves multiple modalities including surgery, radiation and/or chemotherapy. Anthracyclines, one of the first chemotherapeutic agents introduced in the 1960s, has been the backbone for the last 30 years and has been used extensively so far. However, the cardiac toxicity and the concern for secondary hematological malignancy has always been a challenge. A better understanding of the tumor biology, role of Her2 expression and the discovery of trastuzumab and other anti-Her 2 agents along with other effective novel therapeutic options, have revolutionized the treatment for breast cancer. The role of anthracyclines has come under close scrutiny, especially in the adjuvant setting for patients with early stage breast cancer and those with low or intermediate risk of disease recurrence. Recent studies have highlighted such a shift in the use of anthracyclines in both the academic and community clinical practice. However, in patients with a high risk of relapse, anthracyclines still hold promise. Ongoing clinical trials are underway to further define the role of anthracyclines in such a patient population. This review highlights the development, clinical utility, limitations and potential future use of anthracyclines in the adjuvant setting for patients with breast cancer. We consulted PubMed, Scopus, MEDLINE, ASCO annual symposium abstracts, and http://clinicaltrials.gov/ for the purpose of this review.

Keywords: Breast cancer; Adjuvant; Neoadjuvant; Chemotherapy; Anthracyclines

Core tip: A better understanding of the tumor biology along with other effective novel therapeutic options, have revolutionized the treatment for breast cancer. The role of anthracyclines has come under close scrutiny, especially in the adjuvant setting for patients with early stage breast cancer and those with low or intermediate risk of disease recurrence, as per the recent studies. However, in patients with a high risk of relapse, anthracyclines still hold promise. Ongoing clinical trials are underway to further define the role of anthracyclines in such a patient population.