Moving away from toxic treatments for breast cancer
A new paper nearly 15 years in the works argues for eliminating the class of chemotherapy drugs known as anthracyclines from standard treatment for curable breast cancer.
UCLA Health oncologist Sara Hurvitz, MD, started working on the review analysis, published Oct. 8 in the science journal Nature: Breast Cancer, shortly after completing her fellowship in the early 2000s.
“The stack of papers was this high,” she says, holding her hand shoulder-height above her desk to illustrate the mountain of studies she pored over for the paper. “There have been thousands of articles and thousands of studies evaluating the use of this class of therapy for breast cancer. It’s a really rich data set.”
Anthracycline medications, such as Adriamycin (doxorubicin), have been routinely used in breast cancer treatment since the 1970s, despite serious and life-threatening potential side effects including heart failure and leukemia.
But the evidence suggests newer drugs are often just as effective and with fewer risks, says Dr. Hurvitz, director of the Breast Cancer Clinical Research Program at the UCLA Jonsson Comprehensive Cancer Center.
“This review is a very detailed, thorough analysis of all studies relating to anthracyclines and all types of breast cancer and an argument against their routine use in early-stage disease, period,” she says.
“We must keep in mind that most patients with cancer that is confined to the breast and sometimes nearby lymph nodes have a high likelihood of cure with interventions such as surgery, radiation and medicines that do not carry with them life-threatening toxicity,” she said. "Existing evidence suggests it is a small minority of patients who may actutally benefit from the incorporation of anthracyclines into their treatment regimen. We are overusing them to a great extent. One of our aims is to get people to think about the evidence, and the potential harm to patients, before they pull the trigger with anthracyclines.”
While use of anthracyclines have been considered standard practice in many breast-cancer treatment regimens, their toxicity merits more selective use for the patients most likely to benefit, Dr. Hurvitz and her co-authors argue. They call for future clinical trials designed to see whether using this class of drugs in breast cancer treatment is broadly necessary.
“Just using them because we always have isn’t the right approach,” Dr. Hurvitz says.
The new paper analyzes results from studies of various sub-types of breast cancer and how each has responded to different treatment combinations, including those that incorporate anthracyclines and those that don’t.
The review finds that while a small number of studies suggest anthracyclines may improve disease-free survival for patients with advanced disease, the vast majority of breast cancers are diagnosed earlier thanks to regular screenings and can be successfully treated with other medications.
In most cases, the authors argue, less harmful drugs can be just as effective in promoting relapse-free survival and overall survival.
“As we select patients whose disease burden warrants the incorporation of an anthracycline into their regimen, we must also consider carefully that the potential life-altering toxicities associated with anthracyclines are real and are likely underreported,” the authors write.
“Thus, rather than asking which patients can safely be treated without an anthracycline, we should be asking (if) the data clearly exists to warrant the use of an anthracycline, keeping in mind that in many cases we are potentially harming patients more than helping them.”
Learn more about UCLA Health’s Breast Cancer Care.