The status of breast cancer management: challenges and opportunities

Over recent decades, there have been significant advances in the variety of therapies available for the treatment of breast cancer. These developments have produced many improvements in patient response and survival. In primary breast cancer, chemotherapy has been shown to provide significant long-term benefits in the prevention of recurrence and prolongation of patient survival. Similar benefits have been documented for various hormonal manipulations in patients with steroid hormone receptor-positive tumors. Work is ongoing to establish the optimal type and combination of endocrine therapy and chemotherapies. In endocrine-sensitive, metastatic breast cancer, the sequential use of endocrine therapies is considered the optimal strategy, and studies are underway to integrate novel endocrine agents into the management of this disease. For patients with high-risk disease, chemotherapy agents (such as the anthracyclines and taxanes) have exhibited survival benefits, as has the new anticancer monoclonal antibody, trastuzumab. As the number of effective therapies increases, it becomes increasingly important to be able to select the correct combination or sequence of agents. To this end, an important challenge in the development of breast cancer therapy is to use the molecular characterization of the disease as an opportunity to establish and exploit markers of chemosensitivity and resistance, leading eventually to the individualization of therapy for breast cancer patients and to the targeted use of the most appropriate therapies.