What Are Anthracyclines for Breast Cancer?

Medically Reviewed by Melinda Ratini, MS, DO on April 05, 2024
5 min read

Anthracyclines are anti-tumor antibiotics that work on the DNA inside cancer cells. These drugs are made from natural products produced by the soil fungus Streptomyces. They keep the cells from multiplying and tumors from growing. Your doctor can use these medications to help treat breast cancer.

Examples of anthracyclines include:

You’ll usually get anthracyclines through injections or through an intravenous (IV) infusion. The stage of your breast cancer will affect the dose of the medication and how long you’ll need to be on it.

After you have surgery to remove early-stage breast cancer, your doctor may give you chemotherapy to get rid of any breast cancer cells that may be left in your body. This can help lower the risk of the cancer coming back. Experts refer to post-surgery chemotherapy as “adjuvant” chemotherapy.

Anthracyclines are a specific class of medications for adjuvant chemotherapy. They disrupt the enzymes (proteins that help chemical reactions in cells) that copy DNA during a cell’s life. These drugs bind with DNA so that it can’t make copies of itself. That stops cells from reproducing. Your doctor might have you take them alone or in combination with other chemotherapy drugs.

An early look at multiple studies suggests that chemotherapy plans that use an anthracycline might be more successful than chemotherapy without anthracyclines.

These studies included 4,130 women with early-stage, HER2-negative breast cancer that had a high risk of coming back. They were randomly chosen to take one of two chemotherapy treatments.

The anthracycline group consisted of 2,052 people. They took Adriamycin, cyclophosphamide (Cytoxan), with paclitaxel (Taxol), or docetaxel (Taxotere), called “TaxAC.”

The other 2,078 women were in the non-anthracycline group, called TC. They took Taxotere and Cytoxan as their chemotherapy program.

Experts followed both groups for almost 3 years. They looked at the invasive disease-free survival rate, or the amount of time each person lived without developing invasive breast cancer again.

They found that invasive breast cancer did not return in 92.4% of the TaxAC group and 91.7% of the TC group.

With this information, experts confirmed that treatment with anthracyclines is a bit more successful than therapy without them.

These drugs may have mild side effects like:

  • Chills
  • Nausea and vomiting
  • Fever
  • Diarrhea
  • Stomach pain
  • Discolored pee
  • Hives
  • Itchiness
  • A reaction on the injection site
  • Rash
  • Infection
  • Tears that pool in your eyes
  • An overall feeling of being unwell
  • Anorexia
  • Sensitivity to light
  • Discolored nails
  • Changes in skin pigmentation
  • Missing menstrual periods
  • A lower sperm count or no sperm in ejaculation
  • Weakness or lack of energy
  • Coenzyme Q10 deficiency

Moderate side effects could include things like:

Anthracyclines may also cause some serious side effects. The medications could put you at risk for heart damage which could lead to heart failure. In addition, if you’ve taken Adriamycin, you might be more likely to develop leukemia.

As a result, some doctors have started to suggest non-anthracycline chemotherapy routines after surgery. It’s likely that these health risks might also be the reason there’s been a downward trend in the use of anthracyclines.

Anthracyclines are important options for breast cancer treatment. But it’s important that your health care team carefully watches you while you’re on them. Your cardiologist (heart doctor) and oncologist (cancer doctor) should work closely together to lower your chances of heart damage while on anthracyclines. This is especially important for people who have a high risk of developing left ventricle dysfunction.

You may also take liposomal anthracyclines that make regular anthracyclines safer and more effective. This is especially true if you have metastatic breast cancer.

You’ll work closely with your doctor to decide on a cancer treatment that’s right for you. It’s important to consider factors like:

  • The stage of your cancer
  • The hormone-receptor status
  • The HER2 status
  • Lymph node status
  • Your age
  • Whether you’re in menopause
  • Your overall health

If you’re over 60 years old, have high blood pressure, and have had heart issues in the past, your health care team will most likely suggest a chemotherapy routine that doesn’t use anthracyclines.

Experts from the same study above looked at how effective each chemotherapy routine was for people with different types of breast cancer:

Triple-negative breast cancer. This means your cancer is estrogen-receptor-negative, progesterone-receptor-negative, and HER2-negative. The disease-free survival rate over 3 years was:

  • 89.6% for the TaxAC group
  • 86.6% for the TC group

For people with triple-negative breast cancer with no cancer in their lymph nodes, TaxAC routines lowered the risk of redeveloping breast cancer by 2%-2.5% more than the TC routine.

Hormone-receptor-positive breast cancer. The disease-free survival rate over 3 years was:

  • 93.7% for the TaxAC group
  • 94.1% for the TC group

For individuals who had estrogen-receptor positive breast cancer:

  • Those with no cancer in their lymph nodes had about the same turnout in TaxAC and TC routines
  • People with one to three positive nodes had better results with the TaxAC routine. It lowered recurrence risk by 2% to 2.5% more than the TC routine
  • If someone had four or more positive nodes (or those who had triple-negative disease with one of more positive nodes) TaxAC routines lowered the risk of recurrence by 6% to 11% more than the TC routine

Some people’s cancer has progressed to a point where anthracyclines and taxanes don’t work. If this happens, there are other medication options. These include:

For breast cancers that are HER2-positive, one or more drugs that target HER2 may be used with chemotherapy.

Immunotherapy using targeted drug therapy may also be an option.