THE TREATMENT OF THE METASTATIC BREAST CANCER

Abstract

In spite of major advances in early detection and adjuvant therapy, metastatic breast cancer remains a major clinical problem affecting a significant number of patients.

Metastatic disease is generally considered incurable and con ventional therapy is used mainly with palliative intent.

Therefore, the choice of appropriate therapeutic approach requires a reasoned evaluation of the likelihood of benefit from therapy balanced with the impact of therapy on the patient’s quality of life. The estimated aggressiveness of the tumour and indicators of response to therapy (e.g. the sta tus of hormonal receptors) are useful parameters to take into account before selecting a given treatment. Endocrine the rapy is an important option in the management of stage IV disease, with tamoxifen the most widely used first-line drug in postmenopausal women. For progressing patients, the third generation of aromatase inhibitors (letrozole, ana strazole) are considered good second-line endocrine agents.

The LH-RH agonists represent the initial choice in preme nopausal patients candidate to receive hormonal therapy, with the use of tamoxifen as a valuable alternative.

Combination chemotherapy regimes (e.g. CMF or CAF) are usually used for first-line treatment of patients with aggres sive, steroid receptor-negative disease. Recently, several rela tively new agents have shown signifcant activity in meta static breast cancer.

In particular, the taxanes (paclitaxel and docetaxel) are par ticularly promising as single agents but also in combina tion with other drugs, especially anthracyclines.

Finally, another class of agents, the biphosphonates, merits a particular mention because they represent an important new treatment modality in the management of metastatic.