Annals of Oncology Advance Access originally published online on March 28, 2008
Annals of Oncology 2008 19(6):1203; doi:10.1093/annonc/mdn152
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How can we use anthracylines in the management of newly diagnosed metastatic breast cancer patients overexpressing HER-2?
Most women who have metastatic breast cancer (MBC) have had early-stage breast cancer. Therefore, many of them received adjuvant treatment including anthracylines. Starting off with MBC is uncommon. Overexpression of human epidermal growth factor receptor 2 (HER-2), usually as a result of her-2 gene amplification, can result in malignant transformation of cells and is seen in breast tumor tissue in up to 30% of patients with MBC. Trastuzumab with a taxane as first-line therapy is now the standard of care for patients with HER-2-positive MBC [1]. Combinations of trastuzumab with anthracyclines are not recommended outside clinical trials due to increased toxicity [2]. Since most of the patients already received anthracylines in adjuvant setting, it may be rationale not to use anthracylines in HER-2-positive MBC. Furthermore, there is also a concern of anthracyline resistance for these patients. However, newly diagnosed MBC patients overexpressing HER-2 are chemonaive patients. Moreover, the meta-analysis from eight published clinical trials showed that for women with HER2-positive disease, anthracyclines were superior to non-anthracycline-based regimens in disease-free survival and overall survival at adjuvant setting [3]. Information given above may indicate that anthracylines should be an option for the treatment of newly diagnosed MBC patients with HER-2-positive disease. Combination of trastuzumab with less cardiotoxic anthracyclines as liposomal doxorubicin may be a rationale combination or anthracycline-containing regimen may be started after or before the trastuzumab-containing regimen. Further studies are needed to clarify this issue.
Department of Medical Oncology, Hacettepe University Institute of Oncology, Ankara, Turkey
* (E-mail: altundag66{at}yahoo.com)
References
1. Jackisch C. HER-2-positive metastatic breast cancer: optimizing trastuzumab-based therapy. Oncologist (2006) 11(Suppl 1):34–41.
2. Slamon DJ, Leyland-Jones B, Shak S, et al. Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2. N Engl J Med (2001) 344:783–792.
3. Gennari A, Sormani MP, Pronzato P, et al. HER2 status and efficacy of adjuvant anthracyclines in early breast cancer: a pooled analysis of randomized trials. J Natl Cancer Inst (2008) 100:14–20.
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