The Pros and Cons of Breast C... Video Transcript

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People recover very quickly and if we support them throughout the course, it's definitely worth the risks.

RENEE KEMP: Are there different anthracyclines used in adjuvant therapy?

HOPE RUGO, MD: There have been many anthracyclines studied. There are currently two in use. One, doxorubicin or Adriamycin has been around for the longest and it's being used all over the world. The second drug, a newer drug, is epirubicin or Ellence. That drug has been used for sometime in Europe and Canada and has recently been approved in the United States.

RENEE KEMP: And just how do these two differ in their benefits and their side effects?

HOPE RUGO, MD: Doxorubicin is an older drug so it's been around for longer. Epirubicin has been used a lot in Canada and in Europe and it's fairly recent arrival in the United States. It's a very interesting drug because you can give much more of it before you get side effects compared to doxorubicin. So what has happened is that the treatment programs that include epirubicin use a higher dose than the dose of doxorubicin. So using the higher dose you get about the same side effects in terms of the short-term side effects, much less of the heart toxicities. And then in the future you're going to be less worried you could use epirubicin again and you wouldn't have reached your lifetime limit as you have with doxorubicin.

RENEE KEMP: Based on your knowledge of the clinical research can you weigh in on whether one is preferred over the other?

HOPE RUGO, MD: I think it's really very difficult to say right now. There have been no head-to-head comparisons so no one knows the answer to that question. It's probably important to get at least six cycles of an anthracycline treatment program because that's what the epirubicin studies were really modeled after, rather than the standard four cycles given over three months. You should really do it over four months and get six cycles because that may work better.

And then in women who are at high risk for heart toxicity or have very aggressive disease, it would be reasonable to include epirubicin. If you consider including that treatment program because it may be in the long run that that's a more aggressive and effective treatment.

RENEE KEMP: What advice would you give to patients as they go into talk to their doctors about these new treatment options.

HOPE RUGO, MD: I think it's most important for patients to understand what their possible risk of recurrence is and what the benefit from each treatment modality or each treatment type is to reduce their risk. And when they're talking about chemotherapy, I think it's very important for them to understand what is the most effective treatment program that the doctor knows about and what are the alternatives. Because right now, at this date, this year in time, we don't know really that one treatment is better than another. So what a patient really needs to understand is what are their options and what do we know about those options. And then how comfortable her doctor feels with those different treatment programs.

RENEE KEMP: Thank you very much for joining us, Dr. Rugo. Very informative. And thank you for joining our webcast. I'm Renee Kemp.

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