In the last decades, the use of adjuvant systemic treatment for early
breast cancer has increased progressively, and has contributed to the decrease in
breast cancer mortality in the U.S. and in some European countries, although a raising in the disease incidence has been observed. Traditionally, the most extensively used
chemotherapy regimens have been those containing an
anthracycline, namely
doxorubicin or
epirubicin. Due to its more favorable toxic profile,
epirubicin is preferable to
doxorubicin and, in fact, it has been used in the majority of adjuvant studies carried out in Europe. The use of
epirubicin in the U.S. is increasing since 1999, when it was approved by the Food and Drug Administration.
Anthracycline-based regimens are superior to CMF-like combinations. The recent development of
anthracycline-
taxane regimens has shown further benefit in disease-free survival and, in some trials, in overall survival. In patients with HER2-positive
tumors,
trastuzumab has dramatically improved therapeutic results when added to standard adjuvant treatment. It is likely that new technologies (i.e. genomics and proteomics), as well as the appropriate use of translational research along with the development of new molecularly targeted agents, will lead to even greater achievements in the management of early
breast cancer. Nevertheless, it should be considered that at present time
chemotherapy is generally needed either alone or in combination with hormonal or
biologic agents. In particular, the role of
anthracyclines remains unchanged because they have contributed significantly to the improvement of survival of patients with
breast carcinoma.