Therapeutic Aspects Of Metastatic Breast Cancer Chemotherapy

General principles of management, treatment of specific problems related to metastatic disease and systemic treatment of MBC

Robert C.F. Leonard and Thinn P. Pwint

South West Wales Cancer Institute, Singleton Hospital, Swansea, Wales, UK

Abstract: The main treatment aims in managing metastatic breast cancer (MBC) are to relieve symptoms by controlling disease and prolonging survival while maintaining quality of life. Endocrine therapy is considered as a primary option for oestrogen-receptor positive MBC except in those with rapidly progressive visceral disease. Chemotherapy is considered for women with hormone-receptor-negative disease, and in those whose cancer is refractory to endocrine therapy or those with symptomatic or rapidly progressive visceral metastases. The major chemotherapy programmes routinely include anthracycline or taxane but capecitabine, gemcitabine, vinorelbine, and carboplatin are also increasingly used. For HER2- overexpressing breast cancer, trastuzumab-containing chemotherapy is used as a standard but see comments about safe combinations later. Compared with single agent chemotherapy, combination regimens show a greater tumour response rate and improved time to progression in women with metastatic breast cancer, a modest improvement in overall survival but significantly worse toxicities. The newly developed targeted therapies, e.g., Lapatinib are increasingly being investigated for clinical use and potentially leading to the evolution of more effective treatment.

Keywords: relieve symptoms; prolong survival; quality of life; chemotherapy; endocrine therapy; anthracycline; taxane; capecitabine; gemcitabine; vinorelbine; carboplatin; HER2; trastuzumab; single agent chemotherapy; combination; oestrogen-receptor

Each year nearly 800,000 women worldwide are diagnosed with breast cancer, and 314,000 die from the disease. Breast cancer is one of the most frequently diagnosed types of cancer and a second leading cause of cancer death in women after lung cancer (1). Although some improvement of long-term survival has been noted over the past 40 years with the development

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