Breast cancer is the most common malignant tumor in women, and it is now a worldwide consensus that adjuvant chemotherapy after breast cancer surgery can improve survival and reduce recurrence and mortality rates. Anthracyclines have an important role in breast cancer chemotherapy regimens. Wang Shilin, Department of General Surgery, Air Force General Hospital There are several chemotherapy regimens for breast cancer, and the CMF regimen (cyclophosphamide + methotrexate + fluorouracil) is one of them. The initial findings of this regimen were first published in 1976, and the largest beneficiaries were premenopausal patients with 1-3 positive lymph nodes, and it has been extended as a classic regimen for breast cancer chemotherapy until today. Anthracyclines are a class of drugs containing anthracycline ring and belong to the class of antitumor antibiotics. The main ones used in breast cancer chemotherapy are doxorubicin (Adriamycin), epirubicin and pirarubicin. Commonly used anthracycline combination chemotherapy regimens include CAF regimen (cyclophosphamide + doxorubicin + fluorouracil), CEF regimen (cyclophosphamide + epirubicin + fluorouracil), and AC regimen (cyclophosphamide + doxorubicin). Several clinical trials have shown that anthracycline regimens are superior to CMF regimens, and the efficacy of a 4-cycle anthracycline combination chemotherapy regimen is comparable to that of a 6-cycle CMF regimen. The efficacy of anthracyclines correlates with their dose, with recommendations of 30-60 mg/m2 of doxorubicin and 80-100 mg/m2 of epirubicin, repeated every 3 weeks. In terms of basic research, there are two types of anthracyclines with greater benefit: those with abnormal topoisomerase II (Top-II) gene (amplification or absence of vector), and those with overexpression of human epidermal growth factor receptor-2 (HER-2). It is in Top-II that anthracyclines target, thus explaining why anthracyclines are more effective in treating breast cancer. In genetic testing, it was also found that the Top-II gene is adjacent to HER-2 gene, and the co-amplification of both may be more sensitive to anthracycline treatment, but further study is needed as a valid prediction. The relationship between Top-II gene amplification or protein expression and the efficacy of anthracycline chemotherapy has a strong theoretical basis, but the detection of its gene or protein is not widespread in clinical practice. The efficacy of CMF regimens and anthracycline-containing regimens for adjuvant chemotherapy is comparable in HER-2 negative patients. The main side effects of anthracyclines are mainly in two categories: myelosuppression, which is an acute dose-limiting toxicity, and the use of recombinant human granulocyte growth factor (G-CSF) and other drugs, which can increase the single dose of anthracyclines and the number of chemotherapy cycles to a large extent. Another category is cardiotoxicity, which is a chronic dose-accumulation-limiting toxicity. How to avoid cardiotoxicity of anthracyclines: There are several aspects to consider: 1. Use anthracyclines with lower toxicity, such as epirubicin or pirarubicin. 2, anthracyclines cause cardiac lesions may be related to the production of free radicals. Coenzyme Q10, vitamin C, vitamin E, and dexrazoxane have free radical scavenging effects, especially dexrazoxane, which is a more specific drug to prevent anthracycline cardiotoxicity. It is generally recommended that this drug be used to protect patients when they receive a cumulative dose of 300 mg/m2 of doxorubicin. 3. Pay attention to the cumulative dose. If less than the cumulative dose, the incidence of cardiotoxicity is low. 4. To predict the occurrence of cardiotoxicity, left ventricular ejection fraction (LVEF) is currently the best and most practical dynamic monitoring index. The introduction of paclitaxel drugs has further reduced the risk of postoperative recurrence and improved survival, but all relevant phase III international multicenter study protocols are based on anthracyclines. Anthracycline sequential paclitaxel improves RFS rate (recurrence-free survival) and OS rate (overall survival). However, there are also clinical trials showing:No benefit of adjuvant chemotherapy sequential docetaxel in early breast cancer. Triple-negative breast cancer (ER, PR, Her-2 expression negative) is a type of breast cancer that does not benefit from endocrine or molecularly targeted therapy and has a poor prognosis. Anthracyclines have shown some efficacy in triple negative breast cancer, but the poor overall survival rate suggests that combination or sequential therapy with other agents (e.g. paclitaxel) is still needed. In conclusion, anthracyclines still play an important and irreplaceable role in adjuvant chemotherapy for breast cancer due to their more definite and possibly predictable therapeutic effects, preventable and manageable toxic effects, and better cost performance than paclitaxel.