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Rechallenging with anthracyclines and taxanes in metastatic breast cancer

Abstract

Adjuvant use of anthracycline–taxane combination therapy is an accepted strategy in the management of high-risk early-stage breast cancer. However, the introduction of this regimen raises the question of how best to manage those patients who relapse following adjuvant therapy, and whether there is a role for rechallenging in the metastatic setting with the same agent, or class of agent, that has been utilized in the adjuvant setting. This Review examines the evidence for rechallenging with both anthracyclines and taxanes, and highlights the issues that need to be examined in the context of future clinical trials.

Key Points

  • Rechallenge is not a new concept in oncology, and has been used to good effect in other tumors

  • A systematic review in breast cancer has revealed a body of literature relating to rechallenging with anthracyclines and taxanes

  • Current evidence to support rechallenge in the metastatic setting is limited

  • Some taxane studies that are actively recruiting allow inclusion of patients with previous taxane exposure; this could potentially have a deleterious effect on any efficacy analysis

  • Prospective, randomized trials are required to address the clinical utility of rechallenge, and to determine whether it is an appropriate strategy in the metastatic setting

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Authors

Contributions

C. Palmieri and J. Krell are equal first authors on this manuscript. All authors contributed to the research, discussion, writing and editing of this Review.

Corresponding author

Correspondence to Carlo Palmieri.

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Competing interests

C. Palmieri acts as a consultant for Cephalon. D. Miles acts as a consultant for Roche. The other authors declare no competing interests.

Supplementary information

Supplementary Text

Identifying patients who are likely to benefit from rechallenge; Cardiotoxicity of rechallenging with conventional anthracycline-containing regimens; Neurotoxicity of rechallenging with taxane-containing regimens; Overview of the potential efficacy of rechallenging with anthracyclines and taxane; Active clinical trials which allow prior taxane exposure (DOC 58 kb)

Supplementary Table 1

Anthracycline rechallenge (DOC 103 kb)

Supplementary Table 2

Efficacy of liposomal anthracycline-containing regimens (DOC 91 kb)

Supplementary Table 3

Cardiotoxicity in patients rechallenged with an anthracycline or anthracenedione (DOC 69 kb)

Supplementary Table 4

Taxane rechallenge (DOC 75 kb)

Supplementary Table 5

Incidence of neurotoxicity following taxane rechallenge (DOC 52 kb)

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Palmieri, C., Krell, J., James, C. et al. Rechallenging with anthracyclines and taxanes in metastatic breast cancer. Nat Rev Clin Oncol 7, 561–574 (2010). https://doi.org/10.1038/nrclinonc.2010.122

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