Chemo-hormonal therapy for metastatic breast cancer patients: Treatment strategy

In spite of major advances in screening, surgery, radiation therapy, endocrine and chemotherapy (CT) for patients with early-stage breast cancer (BC), there has been only a modest progress in improving survival for women with metastases. Almost all MBC patients are ultimately candidates for systemic therapy, either hormonal or CT. The choice of therapy depends on the disease free interval from the end of adjuvant therapy, whether or not the patient is symptomatic and, if so, the severity these symptoms; and whether the tumour is hormone receptor positive or negative. Standard first-line chemotherapy consists of anthracyclines plus or minus a taxane depending on the end point of treatment. A recently published individual patient’s data metanalysis confirms this concept. Taxane-based combinations were significantly better than A-based combinations in terms of response rate (RR) and progression free survival, but not in terms of survival. Polichemotherapy remain indicated if the end point is citoreduction of high tumour burden. Single agent taxane and single agent A are equivalent in term of RR and overall survival (OS) and are prescribed if the end point is the control of disease and prolongation of survival. First line aromatase inhibitors (steroidal or non-steroidal) and subsequent fulvestrant or an AI of the opposite class is an appropriate sequence for the treatment of advanced endocrine responsive disease. The benefit of an angiogenetic therapy with the scope of blocking certain critical pathways for tumoural cells (for example angiogenesis), has recently been confirmed in at least 2 phase III trials comparing CT with or without bevacizumab. The near future will tell us if a new scenario will become standard in clinical practice.