Epirubicin improves classic chemotherapy for early breast cancer

doi:10.1136/bmj.333.7576.1014-c

BMJ 2006;333:1014 (11 November), doi:10.1136/bmj.333.7576.1014-c

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Epirubicin improves classic chemotherapy for early breast cancer

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Adjuvant chemotherapy reduces the risk of cancerrecurrence and prolongs survival in women with early breastcancer. Traditional regimens of cyclophosphamide, methotrexate,and fluorouracil (CMF) have been around since the 1970s, butit's now clear that regimens including an anthracycline suchas epirubicin work better. Two UK trials confirm this generallyaccepted view, reporting that four cycles of epirubicin followedby four cycles of traditional CMF resulted in longer relapse-freesurvival and longer overall survival than six or eight cyclesof CMF alone (hazard ratio for relapse 0.69 (95% CI 0.58 to0.82), hazard ratio for death 0.67 (0.55 to 0.82)).

In an unusual step, the authors designed andconducted the two trials in parallel, one in England and onein Scotland, before combining the results in a single paper.The bulk of the data came from the English trial, which includedmore than 2000 women. In both trials the anthracycline regimenwas associated with worse side effects, particularly hair loss,nausea, and vomiting. Women treated with epirubicin had a worsequality of life during treatment. Critically, the current follow-upperiod of four years isn't long enough to asses the risk ofmyeloid leukaemia, thought to be about 2% over eight years inwomen treated with epirubicin. Three quarters of the women inboth groups developed amenorrhoea.