Practice Short cuts

Epirubicin improves classic chemotherapy for early breast cancer

BMJ 2006; 333 doi: (Published 09 November 2006) Cite this as: BMJ 2006;333:1014

Adjuvant chemotherapy reduces the risk of cancer recurrence and prolongs survival in women with early breast cancer. Traditional regimens of cyclophosphamide, methotrexate, and fluorouracil (CMF) have been around since the 1970s, but it's now clear that regimens including an anthracycline such as epirubicin work better. Two UK trials confirm this generally accepted view, reporting that four cycles of epirubicin followed by four cycles of traditional CMF resulted in longer relapse-free survival and longer overall survival than six or eight cycles of CMF alone (hazard ratio for relapse 0.69 (95% CI 0.58 to 0.82), hazard ratio for death 0.67 (0.55 to 0.82)).

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


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