Is there a role for intensive therapy in breast cancer?

With reference to survival, polychemotherapy has been demonstrated to be statistically significantly more effective than monochemotherapy both in the adjuvant setting and in the metastatic situation. Breast cancer demonstrates a dose-response relationship. Chemotherapy used in the conventional dose range should be given with adequate dose-intensity both in the adjuvant setting and for metastatic patients. More dose-intensive combinations are almost always associated with a higher response rate in patients' metastatic disease, but these results have seldom been translated into an improved survival. For marrow requiring high-dose therapy, repeated phase II studies have demonstrated the possibility of a survival tail, which may be due to stage migration and patient selection. At present we have at least 13 ongoing phase III studies in the adjuvant setting and at least 5 ongoing studies in the metastatic situation. These studies will give a definite answer on whether marrow-supported high-dose therapy is better than conventional therapy or if alternative approaches using tailored therapy will result in an equivalent outcome. In the future we must make better use of the present arsenal of drugs and examine the marked inter-individual variations in pharmacokinetic profiles for the drugs. We have to tailor the therapy to the tumour biological profile, in both the primary tumour and metastases with appreciation of heterogeneity and tumour progression. Based on these prerequisites, therapy can be either dose-intensive or in some instances continuous using lower doses.