Are Anthracyclines Justified for Breast Cancer?

For the past 2 decades, standard adjuvant chemotherapy for early-stage breast cancer has included an anthracycline. This strategy was supported by results of the Oxford Overview meta-analysis, in which patients who received anthracycline-based adjuvant therapy achieved longer recurrence-free survival (RFS) and overall survival (OS) than counterparts who did not receive an anthracycline (Lancet 2005; 365:1687). However, recent findings indicate that benefits from anthracycline-containing regimens are restricted mainly to the minority of patients with HER2-positive breast tumors. One hypothesis to explain the association between HER2 status and anthracycline response is that HER2 amplification is merely a marker for changes in topoisomerase I…