The role of adjuvant anthracyclines for breast cancer treatment: Can we use molecular predictors?

Anthracyclines have been widely used in the adjuvant treatment of breast cancer and are part of most adjuvant regimens for the treatment of high-risk disease. The 2000 Early Breast Cancer Trialists Collaborative Group overview of polychemotherapy in breast cancer demonstrated that anthracycline-based regimens are superior to non-anthracycline-based therapies in terms of disease-free and overall survival. However, recently, there has been controversy related to anthracycline based on retrospective analyses which showed that only patients with human epidermal growth factor receptor 2 (HER2)-amplified tumors benefited from anthracyclines. However, caution must be used in basing treatments on retrospective data. HER2 should not be the only target used when considering an anthracycline because there may be other suspected molecular predictors of response, such as topoisomerase II alpha ( TOPO II α) gene aberrations (amplifications and deletions), TOPO II α protein overexpression, and DNA repair dysfunction, as well as others as yet undiscovered. Further, TOPO II α gene amplifications and gene deletions have been seen in HER2-negative tumors. This review argues against the use of HER2 as the sole target for predicting response to anthracyclines. [ABSTRACT FROM AUTHOR]