[Chemotherapy for metastatic breast cancer]

Primary goals of treatment in metastatic breast cancer include prevention and palliation of symptoms, maintenance or improvement of quality of life and prolongation of survival. In order to account for the variability of clinical courses, treatment decisions have to be made on an individual basis. Low risk patients without evidence of rapid disease progression or symptomatic disease are mainly considered for endocrine treatment or single agent chemotherapy, whereas patients at higher risk with rapidly progressive or symptomatic disease are candidates for poly-chemotherapies. Anthracyclines are one of the most active group of agents and remain active after adjuvant pre-treatment. The use of liposomal derivatives or weekly or prolonged application can decrease the risk of cardiotoxicity. There is only incomplete cross-resistance between anthracyclines and taxanes. Taxane-based weekly or 3 weekly regimens are therefore generally used in anthracycline-pretreated patients. Capecitabine, gemcitabine, or vinorelbine constitute candidate agents after failure of anthracyclines and/or taxanes and may result in objective responses or disease stabilisation. Data on the continuation beyond third-line chemotherapy are insufficient. Decisions have therefore to be made on an individual basis.