New combinations with epirubicin in advanced breast cancer

Several trials have shown that anthracyclines and taxanes can be combined t o achieve response rates ranging from 70% to 90%, with complete responses r anging from 19% to 41%, In an attempt to increase the activity while mainta ining tolerability, gemcitabine (Gemzar),vas added to the epirubicin (Ellen ce)/paclitaxel (Taxol) regimen. Among 36 metastatic breast cancer patients treated,vith this ne,v combination, the overall response rate,uas 92%, incl uding 31% with a complete response. Another attempt to improve the outcome of metastatic breast cancer patients involves a phase III multicentric rand omized trial (MANTA-1) to evaluate if paclitaxel maintenance therapy after anthracycline/taxane combination therapy can improve time to progression an d overall survival, Although anthracyclines are more frequently used in the adjuvant setting, it is important for the clinicians to know,whether this class of drugs can be used again for those patients who develop metastatic disease. An analysis of 312 patients treated,vith epirubicin containing reg imens as first-line treatment for metastatic disease shows that epirubicin- based regimens are active in patients already exposed to anthracyclines in the adjuvant setting, and that the risk of cardiac toxicity is lo,v lip to a cumulative epirubicin dose of 990 mg/m(2).