How to improve cytotoxic therapy in advanced breast cancer

The optimal cytotoxic treatment of patients with advanced breast cancer is so far not defined. Median survival after first metastatic manifestation is approximately 18 months. No direct evidence for a survival improvement after the introduction of cytotoxic therapy has been published. Major effects have been made to improve treatment efficacy through manipulations of doses, schedules and combinations of known cytotoxic drugs. Three months is probably too short a treatment period. Alternating non-cross resistant regimens offer no advantage over sequential therapy. A dose-response relationship clearly exists in breast cancer, but the higher response rates have not been transformed into a survival benefit. Treatment of advanced breast cancer is palliative, and if, furthermore, we have actually reached a plateau where no further improvement in survival is possible, we will have to evaluate every new treatment modality carefully according to quantity as well as quality of life.