The worldwide perspective in the adjuvant treatment of primary lymph node positive breast cancer.

Adjuvant treatment of early breast cancer has experienced major changes in the last 25 years. Since the mid 1970s when cyclophosphamide, methotrexate and 5-fluorouracil (CMF) resulted in statistically significant and clinically meaningful improvements in disease-free and overall survival, the use of adjuvant chemotherapy has become common practice worldwide. Anthracyclines have long been considered to be among the most active available agents to treat breast cancer and they have become a core component of adjuvant regimens. Anthracycline-containing polychemotherapy regimens provide a significant benefit over CMF. Regimens containing epirubicin are associated with a significant prolongation in relapse-free and overall survival rates compared with standard therapies including CMF. Epirubicin-taxane combinations are highly active in treating metastatic breast cancer and do not appear to be associated with any pharmacokinetic interactions. Epirubicin is a unique anthracycline whose introduction to the US market represents a significant advance in breast cancer treatment. Ongoing research efforts are focusing on combining anthracyclines with taxanes in an effort to continue to improve outcomes following adjuvant therapy.