Anthracycline war: no victor yet.

T hirty years ago, the introduction of anthracyclines, such as doxorubicin and epirubicin, gave oncologists a more effective cytotoxic agent and commenced the drugs ' long reign as the foundation of early breast cancer therapy. But some experts now argue that with the advent of newer drugs — trastuzumab (Herceptin) and the taxanes, such as pacli-taxel (Taxol) and docetaxel (Taxotere) — there is little use for anthracyclines in early disease. Others strongly disagree. At the heart of the controversy is recent evidence suggesting that anthracyclines may work only in women who have extra copies of the HER2 protein or overexpres-sion of the gene. The strength of this evidence is disputed, but if its proponents turn out to be right, it could mean that anthracyclines might not be needed in any form of early breast cancer: If the drugs work only in HER2-positive patients, then it would add no benefi t for women with normal levels of HER2 (often referred to as HER2 negative), who are treated with taxanes. And HER2-positive patients wouldn't need anthracyclines, the argument goes, because it adds no benefi t to trastuzumab, which targets HER2, and taxanes.