SABCS 2024: Anthracyclines May Improve Survival in High-Risk Breast Cancer, But Risks Must Be Weighed

In an interview with Pharmacy Times®, Nan Chen, MD, breast medical oncologist from the University of Chicago, shared that patient with high genomic risk node-negative HR+/HER2- breast cancer saw improved 5-year distant recurrence-free survival when anthracyclines were added to their treatment regimen. However, anthracyclines carry risks of cardiotoxicity and increased hematologic malignancies that must be carefully considered. Chen noted that the overall survival data trended towards improvement, but did not reach statistical significance.

Pharmacy Times

How do anthracyclines impact the long-term outcomes of patients with high genomic risk node-negative HR+/HER2- breast cancer?

Nan Chen, MD

In our study, we found that patients with a 21-gene recurrence score of 31 or greater had an improved 5-year distant recurrence-free interval and distant recurrence-free survival with the addition of anthracyclines to a taxane based regimen. We feel that the addition of anthracyclines in this higher risk population benefits their survival. Our overall survival data was not significant, but it did trend also towards a numerical improvement too.

Pharmacy Times

What are the potential risks and benefits of using anthracyclines in this specific patient population?

Chen

I think the benefits we discussed, which is that you can have an improvement in 5-year distant recurrence-free survival outcomes. There are certainly risks of doing additional chemotherapy. I think 2 specific risks to anthracyclines that are somewhat unique are its risk of cardiotoxicity, as well as this long-term risk of increase of hematologic malignancies. I think both of those things need to be considered when you're deciding with your patient whether additional anthracycline therapy would be beneficial or not.

Pharmacy Times

How do anthracyclines affect the risk of late toxicities in high genomic risk patients?

Chen

I think that they need to be considered. I'm not aware of any data that having a hydro genomic risk increases your risk of late toxicities to anthracycline, but I think it's definitely something to consider. Especially for example, in patients who already have preexisting cardiac disease, or patients who may have some increased risk of hematologic malignancies outside of their breast cancer and outside of their treatment.