A careful reassessment of anthracycline use in curable breast cancer.

A clear trend toward differential RFS and OS benefit with anthracycline-based therapy in TOP2A amplified (ratio > 2) cancers was noted but did not meet statistical significance.

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In contrast, patients with HER2− breast cancers had virtually overlapping outcomes with anthracycline vs non-anthracycline-based therapy, with a slight trend toward better outcomes with CMF treatment (DFS HER2− RR = 1.02; OSHER2− RR = 1.07).

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Outcomes tended to be better in patients with HER2 overexpressing breast cancer treated with AC-based therapy (DFS for HER2+, RR = 0.84, OS for HER2+, RR = 0.82), though this also did not reach statistical significance.

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Several additional studies 77 , 78 , 95 – 98 also showed a trend toward a positive relationship between the HER2 alteration and benefit from dose intense anthracyclines.

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Similarly, HER2 analysis ( N = 506) from a study in Milan 79 demonstrated a strong trend toward survival benefit with anthracyclines only in those with HER2-overexpressing disease (OS CMF-A vs CMF HER2+: HR = 0.61, HER2− HR:1.26; p interaction = 0.052).

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