Chemotherapeutic approaches to advanced breast cancer

Choices of treatment for patients with estrogen receptor (ER) positive metastatic breast cancer refractory to first-line endocrine therapies include progestins, antiadrenal drugs, and androgens. These treatments should be administered sequentially to achieve maximum palliation of the disease. For ER positive patients with disease that is refractory to endocrine therapies, chemotherapy of choice includes either CMF (cyclophosphamide, methotrexate, fluorouracil) or FAC (fluorouracil, doxorubicin, cyclophosphamide), which is CMF with doxorubicin substituted for methotrexate. Choices of therapy for those with disease refractory to CMF combinations include doxorubicin and vinca alkaloids or mitomycin C combinations. These combinations result in 45% to 55% response rates. For those who do not respond to FAC, the combinations active in refractory disease include vinca alkaloids and mitomycin C combinations. Other drugs with 15% to 25% antitumor activity include mitoxantrone, elliptinium acetate, CHIP (cis-dichloro-transdihydroxy-bis-isoprophylamine platinum), peptichemio, and fluorouracil infusion.