EJC Supplements
Volume 9, Issue 2 , Pages 1-4, October 2011

Introduction

  • Dino Amadori

      Affiliations

    • Corresponding Author InformationCorrespondence: Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.) S.r.l., Via Piero Maroncelli, 40-47014 Meldola (FC), Italy. Tel.: +390543 739912; fax: +390543 739249

Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy

Article Outline

Abstract 

Since their introduction in the 1960s, anthracyclines such as doxorubicin have attained a central place in the management of a number of solid tumours and haematological malignancies. Anthracycline-based regimens constitute a standard of care in patients with metastatic breast cancer; anthracycline monotherapy compares favourably with taxanes alone, while combinations of anthracyclines and taxanes have been shown to be superior to anthracycline-based regimens in terms of response rates and progression-free survival. Similarly, in patients with early breast cancer, adjuvant therapy with anthracycline-based regimens significantly reduces breast cancer mortality, compared with cyclophosphamide-methotrexate-fluorouracil regimens. However, a major limitation to the use of anthracyclines is cumulative cardiotoxicity, which can result in irreversible congestive heart failure. A number of strategies to reduce cardiotoxicity have been investigated, including modification of the dosing regimen, use of cardioprotective agents, and the development of liposomal doxorubicin formulations. The central place of anthracyclines in breast cancer management is likely to continue: the challenge now is to identify those patients most likely to respond to, and benefit from, anthracyclinebased therapy.

Keywords:  Anthracyclines , Breast cancer , Doxorubicin , Drug toxicity , Liposomal doxorubicin

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Piccart-Gebhart MJ , Burzykowski T , Buyse M , et al.   Taxanes alone or in combination with anthracyclines as first-line therapy of patients with metastatic breast cancer . J Clin Oncol . 2008;26:1980–1986
  2. Gianni L , Norton L , Wolmark N , Suter TM , Bonadonna G , Hortobagyi GN . Role of anthracyclines in the treatment of early breast cancer . J Clin Oncol . 2009;27:4798–4808
  3. Oakman C , Moretti E , Di Leo A . Re-searching anthracycline therapy . Breast Cancer Res Treat . 2010;123:171–175
  4. Di Marco A , Gaetani M , Scarpinato B . Adriamycin (NSC-123,127): a new antibiotic with antitumor activity . Cancer Chemother Rep . 1969;53:33–37
  5. Bonadonna G , Monfardini S , de Lena M , Fossati-Bellani F . Clinical evaluation of adriamycin, a new antitumour antibiotic . BMJ . 1969;3:503–506
  6. Smalley RV , Carpenter J , Bartolucci A , Vogel C , Krauss S . A comparison of cyclophosphamide, adriamycin, 5-fluorouracil (CAF) and cyclophosphamide, methotrexate, 5-fluorouracil, vincristine, prednisone (CMFVP) in patients with metastatic breast cancer: a Southeastern Cancer Study Group project . Cancer . 1977;40:625–632
  7. Bergh J , Jönsson PE , Glimelius B , Nygren P . A systematic overview of chemotherapy effects in breast cancer . Acta Oncol . 2001;40:253–281
  8. Lord S , Ghersi D , Gattellari M , Wortley S , Wilcken N , Simes J . Antitumour antibiotic containing regimens for metastatic breast cancer . Cochrane Database Syst Rev . 2004;4: CD003367
  9. Martin M , Villar A , Sole-Calvo A , et al.   Doxorubicin in combination with fluorouracil and cyclophosphamide (i.v. FAC regimen, day 1, 21) versus methotrexate in combination with fluorouracil and cyclophosphamide (i.v. CMF regimen, day 1, 21) as adjuvant chemotherapy for operable breast cancer: a study by the GEICAM group . Ann Oncol . 2003;14:833–842
  10. Early Breast Cancer Trialists' Collaborative Group (EBCTCG) . Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials . Lancet . 2005;365:1687–1717
  11. Von Hoff DD , Layard MW , Basa P , et al.   Risk factors for doxorubicin-induced congestive heart failure . Ann Intern Med . 1979;91:710–717
  12. Hortobágyi GN . Anthracyclines in the treatment of cancer. An overview . Drugs . 1997;54(Suppl 4):1–7
  13. van Dalen EC , Michiels EM , Caron HN , Kremer LC . Different anthracycline derivates for reducing cardiotoxicity in cancer patients . Cochrane Database Syst Rev . 2006;4: CD005006.
  14. Namer M , Khater R , Boublil JL , Héry M , Thyss A , Bourry J . [Adriamycin in low weekly doses. Latest therapy of advanced cancer of the breast] . Presse Med . 1986;15:1315–1317
  15. Legha SS , Benjamin RS , Mackay B , et al.   Reduction of doxorubicin cardiotoxicity by prolonged continuous intravenous infusion . Ann Intern Med . 1982;96:133–139
  16. Speyer JL , Green MD , Zeleniuch-Jacquotte A , et al.   ICRF-187 permits longer treatment with doxorubicin in women with breast cancer . J Clin Oncol . 1992;10:117–127
  17. van Dalen EC , Caron HN , Dickinson HO , Kremer LC . Cardioprotective interventions for cancer patients receiving anthracyclines . Cochrane Database Syst Rev . 2008;2: CD003917.
  18. Wigler N , Moshe I , O'Brien M , et al.   Reduced cardiac toxicity and comparable efficacy in a phase III trial of pegylated liposomal doxorubicin (CAELYX(tm)/Doxil) vs. doxorubicin for first-line treatment of metastatic breast cancer . Proc Am Soc Clin Oncol . 2002;21:45a; (abs 177).
  19. O'Brien MER , Wigler N , Inbar M , et al.   Reduced cardiotoxicity and comparable efficacy in a phase III trial of pegylated liposomal doxorubicin HCl (CAELYX(tm)/Doxil®) versus conventional doxorubicin for first-line treatment of metastatic breast cancer . Ann Oncol . 2004;15:440–449
  20. Cortes J , Di Cosimo S , Climent MA , et al.   Nonpegylated liposomal doxorubicin (TLC-D99), paclitaxel, and trastuzumab in HER-2-overexpressing breast cancer: a multicenter phase I/II study . Clin Cancer Res . 2009;15:307–314
  21. Antón A , Ruiz A , Seguí MA , et al.   Phase I clinical trial of liposomal-encapsulated doxorubicin citrate and docetaxel, associated with trastuzumab, as neo-adjuvant treatment in stages II and IIIA, HER2-overexpressing breast cancer patients. GEICAM 2003-03 study . Ann Oncol . 2009;20:454–459

PII: S1359-6349(11)00068-1

doi:10.1016/S1359-6349(11)00068-1

EJC Supplements
Volume 9, Issue 2 , Pages 1-4, October 2011

Article Tools