HYMAN B. MUSS, MD: There's a very wonderful thing that we've all participated in clinical trials called the Worldwide Overview, and they have data on about 190,000 women from all over the world, many American women, Canadian women who have been put in randomized trials comparing one drug with another by a coin flip, and in their trials, they've looked at the anthracyclines versus more traditional therapies like CMF, which are among the original adjuvant therapies that were so successful in improving survival. In the overview, the use of anthracyclines has further added to the benefits of CMF by about 10 to 15 percent. In those overviews, which are pretty convincing overall, I think it's pushed many physicians to consider anthracycline use. But again, in older women -- for instance, in their 70s -- and people with heart disease and others, their use is of great concern.
CATHY CONLEY: Doctor, what are the side effects of anthracyclines, and is there a difference between the two agents?
HYMAN B. MUSS, MD: Well, anthracyclines' major side effect is lowering blood counts. Both epirubicin and doxorubicin can be very damaging to the marrow. It's a transient effect in most patients, lower counts. When you have low blood counts, especially low white cell counts, you're at higher risk of infection, and that is the most dangerous side effect of chemotherapy.
Other side effects, like nausea and vomiting, we're actually very good with these days. Thinks like mouth sores, which can be very rough to have, are probably similar among the agents, and then, as we talked about with cardiac toxicity, the heart damage, probably in the doses they're given, it's probably not a major problem for either anthracycline if a patient is closely monitored. When you get to high doses, there might be some advantage for epirubicin.
CATHY CONLEY: Dr. Pritchard, is there anything you'd like to add?
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