Chemotherapy and hormonal therapy for breast cancer

Significant incremental advances in the use of systemic hormonal therapy and chemotherapy for the treatment of breast cancer have occurred in the past few years. Benefits of systemic therapy can be broadly divided into two major categories. The first is the favorable impact of systemic adjuvant therapy on recurrence and survival following primary surgical therapy for early stage disease. In this setting, both hormonal therapy and chemotherapy are effective. The results of recent trials as well as an overview analysis of randomized studies, have been able to further delineate, although not unequivocally, for which populations of patients a given type of therapy is most efficacious. Additionally, a more precise estimate of the reduction in odds of relapse and death afforded by a given therapy and within a defined patient subgroups is now possible, and these may be helpful in guiding clinical decision-making. Second, the treatment of advanced metastatic disease remains challenging due to the inability to induce long-term remissions or cures despite common initial responsiveness to hormonal therapy or chemotherapy. Over the last decade, only a few new drugs have been approved for the treatment of breast cancer, although several promising chemotherapeutic and biological agents are under scientific and clinical development. The use of therapy in this setting is therefore currently aimed at improving symptoms and quality of life. The use of conventional and novel chemotherapeutic agents at escalated doses with the use of hematopoietic growth factors, peripheral stem cells or autologous marrow support in terms of improved response rates and the potential to prolong survival, achieve long-terms remissions or cures, and improve quality of life is under active investigation.