anthracyclines to become an adjuvant chemo of the past?

[dlaxague]

Hello all,

Did anyone watch the Project LEAD webcast this evening presented by Dennis Slamon? It was about anthracyclines. Some of it was what he presented at SABCS last year. He has not released the full results yet but much of what he based his discussion on is research that has already been completed.

He admitted that this is a controversial topic but that he does not understand why there is opposition to dropping anthracyclines, because there is not a single study that supports anthracycline efficacy over other chemotherapies. Most recent "others" looked at have been TC and TCH, but CMF has been compared also.

The apparent increased benefit offered by anthracyclines, upon closer analysis, is limited to only HER2+ cancer, and upon even closer analysis, to only HER2+ cancer that also overexpress topo2a (I think he wrote it as TOPO IIa, I'm being lazy). HER2+ cancers overexpress topo2a about 1/3 of the time. HER2 negative (he made mention of HER2 "normal", rather than negative) cancers never overexpress topo2a. So the increased benefit of an anthracycline exists only for a small percent of all breast cancer - 1/3 of the 1/4 of all breast cancer that are HER2+.

Even more important, when Herceptin (and/or probably Tykerb) is used, there is no additional benefit to using an anthracycline (even for topo2a + cancers), and there is significant increase in potential harm, including increasing risk of heart damage and of leukemia.

Bottom line statement by Dr. Slamon was that there is no place today for anthracyclines in adjuvant treatment for anyone, except in countries that do not have access/can't afford Herceptin.

He also stated that epirubicin is not any better than adriamycin. He said that studies that seemed to show that did not compare equivalent doses of the two anthracyclines.

Dr. Slamon said that his results probably would not be released in time for SABCS - he thought more likely ASCO.

The webcast will be archived on the NBCCF's Project LEAD website. I do not know when that will happen.

And lastly, when this information about anthracyclines first came out, many women interpreted it to say that the anthracycline they received for adjuvant treatment "had been for nothing". That is not what this is saying. It is saying that all chemos offer benefit. Anthracyclines offer benefit, they just do not offer any INCREASED benefit over other chemos and they have more serious side effects so they do increase harm. No increased benefit but increased harm = "why are we using this class of drug?"

Debbie Laxague