Dr Waks on Anthracycline- vs Taxane-Based Therapy in HER2+ Breast Cancer

Adrienne G. Waks, MD, physician, associate director, Breast Oncology Clinical Research, Dana-Farber Cancer Institute, assistant professor, medicine, Harvard Medical School, discusses how the efficacy and safety profiles of anthracycline- and taxane-based regimens compare with one another as neoadjuvant and adjuvant treatment options for patients with HER2-positive breast cancer.

When comparing anthracycline- and taxane-based regimens as neoadjuvant treatment options for patients with HER2-positive breast cancer, it’s crucial to consider the differences in toxicity, Waks begins. Anthracycline-based regimens, especially when combined with HER2-targeted agents, are associated with a higher risk of cardiotoxicity, according to Waks. Additionally, there is a slightly increased risk of secondary leukemias associated with anthracycline-containing regimens, she explains. These differences in toxicity profiles are significant and have been well documented across various studies, Waks notes.

Regarding efficacy, current data indicate that anthracycline- and taxane-based regimens provide comparable long-term protection against recurrence in HER2-positive breast cancer, she continues. However, it’s important to note that the existing studies were not specifically designed or powered to directly compare long-term outcomes between anthracycline and non-anthracycline chemotherapy backbones, Waks notes. Although the available data are reassuring in terms of efficacy, they are not definitive for long-term outcomes, she reports.

Given the established differences in toxicity and the lack of conclusive data favoring one regimen over the other in terms of long-term efficacy, the current standard of care for most patients with HER2-positive breast cancer involves omitting anthracyclines in both the neoadjuvant and adjuvant settings, Waks states. This treatment approach minimizes the risk of cardiotoxicity and other potential adverse effects and still provides effective treatment for HER2-positive breast cancer, Waks says. In summary, the decision to omit anthracyclines is supported by both the toxicity profile and the reassuring, albeit not definitive, data on long-term outcomes, making it the preferred choice for most patients, she concludes.