Personalizing Chemotherapy in Early Breast Cancer: Using Genomic Risk to Guide Anthracycline Use

In this interview with Pharmacy Times, Lee Schwartzberg, MD, FACP, discusses the long-standing role of anthracyclines in breast cancer treatment and the significant short- and long-term toxicities associated with their use, including cardiac damage and secondary malignancies. He explains why minimizing unnecessary exposure to these agents is critical, particularly for patients who may never experience disease recurrence. Dr. Schwartzberg highlights how advances in genomic testing, including MammaPrint and BluePrint, have enabled clinicians to better stratify patients by risk and tailor therapy accordingly. He reviews findings from the FLEX registry, which demonstrated that patients in the high-risk 2 category derive substantial benefit from anthracycline-containing regimens, with more than a 10% improvement in invasive disease-free survival. In contrast, patients in the high-risk 1 category did not show similar benefit and can often be treated effectively with lower-intensity chemotherapy.