Treatment of metastatic breast cancer and its complications

Measurement of quality of life is becoming increasingly important in the evaluation of treatment for metastatic breast cancer. New approaches to endocrine treatment include use of toremifene and trilostane. The addition of fluoxymesterone to tamoxifen is reported to enhance response frequency. The relationship between dose and response for anthracycline treatment has been reaffirmed. Measurement of left ventricular ejection fraction may not be a useful predictor of clinical cardiotoxicity. The new anthracyclines, idarubicin and pirarubicin, are active in breast cancer, the former being suitable for oral administration. Several new cytotoxic drug combinations have been reported, but have no clear advantages over existing regimens. Intensification of chemotherapy facilitated by autologous bone marrow transplantation or hematopoietic growth factors is feasible; high response rates can be achieved, but with severe toxicity. This approach remains investigational and has not yet achieved an established place in routine treatment. Progress has been made in the reduction of morbidity from bone metastases by use of bisphosphonates and therapeutic isotopes.