Low weekly doses of doxorubicin and epidoxorubicin in second line chemotherapy of advanced breast cancer

Study objectives were to assess the efficacy and tolerance of two anthracyclines: doxorubicin (DXR) and epidoxorubicin (EpiDX) given weekly at low doses in patients with advanced breast cancer not amenable to aggressive chemotherapy. One hundred and twenty two patients (age 32-82 years, median 56 years, median PS 2, range 0-4) were entered of whom 58 received DXR and EpiDX. The choice of one of the two anthracyclines used was left to the discretion of the treating physician. The two groups of patients were well balanced for age, previous therapy, PS and target lesions. Both anthracyclines were given i.v. weekly at a dose/course of 20 mg (DXR) and 30 mg (EpiDX). All patients were assessed for toxicity and 116 were assessed for response. An objective response (CR + PR) was seen in 24 of 58 DXR patients (41%) and in 26 of 64 those given EpiDX (41%). The median duration of response for both drugs was 6 and 5 months, respectively. Treatment was well tolerated. Alopecia, gastrointestinal, hematological and cardiac toxicities were mild and similar in patients given DXR and EpiDX. No toxicity was seen in about 40% of the patients. In conclusion, this study demonstrated usefulness and similar activity of low weekly doses of both anthracyclines. This approach seems to be a reasonable alternative to standard second line chemotherapy and is a treatment of choice in patients not amenable to more aggressive schedules.