In a debate about the benefit of anthracycline therapy at the Symposium, Stephen E. Jones, MD, of US Oncology Research, The Woodlands, Texas, advocated for greater use of non–anthracycline-containing regimens. Dr. Jones was the principal investigator of US Oncology Research Trial 9735,1 which found superior overall survival with TC (docetaxel/cyclophosphamide) vs classic anthracycline chemotherapy (87% vs 82%) as well as superior disease-free survival (81% vs 75%, respectively). They also found fewer instances of congestive heart failure and bone marrow damage in the TC arm, he pointed out.
“Since the publication of this study, the use of the TC regimen in the United States has increased dramatically, thereby sparing many women the exposure to anthracyclines,” he said.
Dr. Jones said the ideal number of cycles of TC chemotherapy has still not been determined, but six cycles are being evaluated in prospective studies.
“I believe that the TC regimen will be equal to anthracycline regimens for most women with HER-2-negative disease,” he said. “However, whether there is a subset of patients who benefit from anthracyclines (eg, triple-negative disease) based on some mechanism of action other than topoisomerase II alpha gene expression remains to be answered.” Studies are underway to help answer this question, he said. ■
Disclosure: Dr. Jones reported no potential conflicts of interest.
1. Jones SE, Holmes FA, O’Shaughnessy JA, et al: Docetaxel with cyclophosphamide is associated with an overall survival benefit compared with doxorubicin and cyclophosphamide: 7-year follow-up of U.S. Oncology Research Trial 9735. J Clin Oncol 27:1177-1183, 2009.
Anthracycline use in early-stage breast cancer has been steadily declining, especially for patients with stage I/II or HER2-positive disease, according to an analysis of patients treated at the University of California, San Francisco (UCSF) School of Medicine.1