Anthracyclines for Breast Can... Video Transcript

Webcast Transcript

CATHY CONLEY: Are there differences in the way the epirubicin and the doxorubicin are used, and does it vary in the different stages of the disease?

HYMAN B. MUSS, MD: Well, I think historically they've been very similar in the way they've been used. Initially, both were used in women with metastatic breast cancer, which is where we learn how effective treatments are. Now, and for many years, adriamycin or doxorubicin, which was an earlier developed drug, was tested in the early setting and very promising. More recently, epirubicin, which has actually been around for a long time, has been rediscovered, in a sense, and put into several very high-quality adjuvant therapy trials, where it's shown to be superior to some of the other standards of care.

CATHY CONLEY: Can you talk about the difference in toxicity between the two agents?

HYMAN B. MUSS, MD: The anthracyclines cause heart damage by damaging heart muscle. It's not like a coronary, like a heart attack. They don't cause heart attacks. What they cause your heart to do is not pump well and lead to heart failure.

Fortunately, with all the agents, and when given appropriately, and when patients are closely followed by their physicians and nurses, it's usually not a major problem, but it can be. In women with metastatic breast cancer, where their breast cancer is a major problem and it's not going to be a curable event, heart failure is of concern, but unfortunately most of those women don't live many, many years, and so your goal of treatment is to do the best for the breast cancer at that time.

In the adjuvant setting, where many women hopefully are never going to have a problem with breast cancer again, you're concerned what's going to happen at five and ten years, so it's very important up front that we minimize damage to the heart. There's some evidence that epirubicin, when given at a dosage that has a similar effect on cancer cells as doxorubicin, may be a little less cardiotoxic, and perhaps that is an advantage.

CATHY CONLEY: Well, doctor, how do you think the use of anthracyclines will change over the next few years with all the information, all the breast cancer therapies and how it is incorporated into the practice?

HYMAN B. MUSS, MD: I think we're trying to learn who benefits most by various drugs. For instance, we know that anthracyclines as a group of drugs are superior to non-anthracycline regimens. But we'd like to identify which of the patients are most likely to benefit. We're going to look for the targets. We're interested in looking at our patients as they come into the clinic and saying, "We've tested your breast cancer, and you have chemical X, and we know, by having chemical X, you should get an anthracycline-containing treatment, because it's going to do better."

CATHY CONLEY: Dr. Rugo, your final comments?

HOPE RUGO, MD: I do think that the use of anthracyclines is going to change, to use a longer treatment program. So instead of a three-month course of four cycles, we may be using a four-and-a-half month course of six cycles. If that's the case, I think there's going to be increasing use of epirubicin rather than doxorubicin, because we can use those six cycles without reaching the lifetime maximum dose of anthracycline.

CATHY CONLEY: Well, Dr. Hope Rugo, thanks so much for your time. We appreciate you being with us.

HOPE RUGO, MD: Thank you very much.

CATHY CONLEY: Dr. Hyman Muss, thank you for joining us.

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