Early experience suggested that the greater than 40% objective response rate (ORR) seen with anthracyclines in advanced breast cancer could be matched by monotherapy with the taxane, docetaxel. It was also suggested that using an anthracycline in combination with a taxane could reliably increase the ORR to 50% or more.
While the use of docetaxel in combination with doxorubicin is now relatively commonplace, in the mid-1990s there was considerable concern that the combination of a taxane with an anthracycline might result in unacceptable cardiotoxicity. This followed publication of data suggesting that the administration of paclitaxel in patients with a greater than 360 mg/m2 cumulative exposure to doxorubicin might result in a 20% or greater incidence of congestive heart failure. However, with the docetaxel/anthracycline combination, docetaxel did not appear to increase the incidence or severity of cardiotoxicity observed with doxorubicin alone. Epirubicine is a less cardiotoxic anthracycline and there have been many studies on combining it with taxanes. It shoud be considered a standard option for metastatic breast cancer.