Thread by @drvineetgovinda

Thanks to all my colleagues for voting. This is an interesting question in breast oncology, and practice varies quite a bit (As you can see from the poll)
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There is interest in getting rid of anthracyclines from adjuvant chemotherapy of breast cancer, due to long-term concerns of heart failure and secondary leukemia. The ABC meta-analysis seemed to concur that taxane+anthracycline (TaxAC) beats 6TC by a small margin
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An unplanned subgroup analysis revealed interaction with number of nodes in HR+ patients, with no benefit in HR+ N0 disease.
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The West German PlanB study compared 6TC to TaxAC in high-risk patients (although lower risk overall than ABC). Of interest, the subgroup analysis reveals no difference in outcomes based on OncotypeDx Recurrence score.
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Two important caveats:
1. PlanB used non-dose dense chemotherapy and TaxAC chemotherapy regimens varied in ABC.
2. Both studies used 6TC as the comparator arm, although 4TC is popular (see poll)

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The final question is still open. Which HR+ N0 patients do you treat with TC instead of TaxAC? None? Only those with contraindications to anthracyclines? Or all?
Importantly, if you are planning TC, patients should not be "upgraded" to TaxAC just because of high RS.

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