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One of the most common chemotherapy drugs used for the treatment of persons with advanced breast cancer is doxorubicin, an agent belonging to the class of drugs called anthracyclines. Although doxorubicin (in combination with other chemtherapy drugs) is effective, its use can result in damage to the heart, which can in turn limit the amount of the drug that can be given to fight the breast cancer. Researchers now report that another anthracycline, called epirubicin, may cause less damage to the heart and allow higher doses of the drug to be used, making epirubicin a potentially effective alternative to combination chemotherapies used to treat breast cancer.

Treatment for cancer of the breast, a common cancer in women, is dependent on many factors. One of the main considerations in making a treatment choice is the stage of cancer, or the extent of disease at the time of diagnosis. In the case of advanced breast cancer of stage IIIB (the cancer has spread to tissues near the breast or to lymph nodes inside the chest) or stage IV (the cancer has spread to other parts of the body), treatment options may include chemotherapy combinations, radiation therapy, hormone therapy, biologic therapy (to help the immune system fight the cancer), and/or sometimes surgery.

Researchers at the Indiana University and University of Arkansas treated 27 newly diagnosed persons with locally advanced (stage IIIB) or metastatic (stage IV) breast cancer with high doses of epirubicin. The patients received single high doses of the drug every 3 weeks for a maximum of 8 treatment cycles. The results showed an overall response rate of 79%, with 22% having complete responses. Side effects included mainly low blood counts.

These researchers concluded that epirubicin (at high doses) is 1 of the most active chemotherapy drugs against advanced breast cancer, achieving responses similar to those of active combination chemotherapy regimens. Further study is needed to investigate the use of epirubicin with biologic therapies, such as Neupogen®, to determine whether this would assist with low blood counts and result in more effective treatment. Furthermore, the potential use of epirubicin in combination therapies, supported by autologous peripheral blood stem cells, warrants further study. (

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Cancer, Vol 88, No 2, pp 375-380, 2000)

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