Adjuvant chemotherapy for early breast cancer: optimal use of epirubicin.

Anthracyclines are central components of adjuvant combination chemotherapy regimens for early breast cancer. Epirubicin is underutilized for this indication in the United States, where it was approved by the Food and Drug Administration in 1999, compared to Europe and Canada, where it gained approval in 1980. Use of epirubicin offers advantages in specific treatment settings and patient subsets, including situations where use of dose-dense and/or dose-intense protocols may provide additional benefits and where combinations including taxanes and/or trastuzumab may provide increased efficacy. Epirubicin also has a distinct safety profile compared to doxorubicin with regard to cardiotoxicity. In order to optimize treatment benefits and safety concerns for node-positive, node-negative and HER-2-positive patients as well as patients receiving neoadjuvant therapy and elderly patients it is worthwhile to consider the potential benefits of epirubicin.