Indications for cytostatic therapy in metastatic breast cancer

Generalized breast cancer is always incurable. The heterogeneity of this disease is reflected by wide variation in treatment response and survival duration. No well-defined factors have been found which can distinguish the patients most likely to benefit from chemotherapy. No superior drug combination or schedule has been convincingly established, and basic facts on quality of life issues are still lacking. The most important treatment goal is to provide meaningful palliation for the individual patient. Indications for chemotherapy are life-threatening disease, distant metastases in receptor-negative disease, and clinically hormone resistant disease. In future trials the importance of potentially relevant biological factors for treatment should be evaluated, and such analyses should, at least partly, replace the presently conducted phase II and phase III studies.