Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA.
Breast Cancer Res Treat. 2010 Jan;119(1):25-32. doi: 10.1007/s10549-009-0567-y.
Long-term toxicity of adjuvant regimens is a critical consideration given improvements in survival and consequential management of treatment-related side effects. Despite their well-documented long-term side effects, including a cumulative dose-dependent cardiotoxicity and an increase in the incidence of secondary leukemia, anthracyclines remain an integral component of many adjuvant regimens for breast cancer. The utility of HER-2/TOP2A coamplification in predicting sensitivity to anthracycline chemotherapy has been widely suggested but requires substantiation. The recent maturation of two large phase III trials that directly examined the substitution of a taxane for an anthracycline in the adjuvant setting provides further data to critically evaluate the standard use of anthracyclines in the treatment of early-stage breast cancer. Results from both US Oncology 9735 and BCIRG 006 demonstrated equivalent efficacies in taxane- and anthracycline comparator arms. However, in both trials, the taxane-based regimen(s) resulted in less relative toxicity than the anthracycline-based regimen(s). These trial results pose legitimate questions regarding the future application of anthracyclines in the adjuvant breast cancer setting.
鉴于生存状况的改善和随之而来的治疗相关副作用的管理，佐剂方案的长期毒性是一个关键的考虑因素。尽管蒽环类药物有充分的长期副作用记录，包括累积剂量依赖性心脏毒性和继发性白血病发病率增加，但它们仍然是许多乳腺癌辅助治疗方案的重要组成部分。HER-2/TOP2A 共扩增在预测对蒽环类化疗药物的敏感性方面具有广泛的应用价值，但需要证实。最近两项大型 III 期临床试验的成熟，直接研究了在辅助治疗环境中用紫杉烷替代蒽环类药物，提供了进一步的数据来批判性地评估蒽环类药物在早期乳腺癌治疗中的标准应用。来自美国肿瘤学 9735 和 BCIRG 006 的结果表明，在紫杉烷和蒽环类比较组中，疗效相当。然而，在这两项试验中，基于紫杉烷的方案比基于蒽环类的方案的相对毒性更小。这些试验结果对蒽环类药物在辅助乳腺癌治疗中的未来应用提出了合理的问题。
