Present status of anthracyclines in the adjuvant treatment of breast cancer.

Anthracyclines represent the most active cytotoxic agents against metastatic breast cancer. The introduction of these drugs into the adjuvant therapy of breast cancer was slow because of concern related to chronic toxicities. However, there is clinical evidence of the safety and efficacy of doxorubicin-containing adjuvant regimens with follow-up periods that now approach 19 years. Adjuvant chemotherapy trials performed at the University of Texas M.D. Anderson Cancer Center demonstrate that doxorubicin can be administered in the adjuvant setting with tolerable and reversible acute side effects, and minimal long term toxicity. Over the last 15 years, a number of prospective randomised trials have compared doxorubicin-containing regimens versus those not containing doxorubicin in the adjuvant therapy of early breast cancer. Several of these trials have demonstrated disease-free survival benefit of the doxorubicin-containing regimens; some have also shown a definite overall survival gain. Several other trials in progress will need additional follow-up for definitive analysis. Thus, doxorubicin-containing adjuvant chemotherapy is effective, tolerable, and safe for adjuvant therapy of breast cancer.