[Cytostatic therapy in metastatic breast cancer]

Although no breast cancer patient can be cured after metastases have been found, the fact that survival is prolonged and the symptoms and signs of advanced disease can be relieved, often impressively, by the administration of cytostatic chemotherapy justifies their implementation. Chemotherapy is only one aspect of a comprehensive treatment modality in this controversial field and has to be strictly reviewed in the light of indications and contraindications in every single patient. Step-by-step development over the past twenty years has proven the clear-cut advantages of polychemotherapy over a single-drug regimen. Adriamycin, the parent drug of the large group of anthracyclines has proved to be a highly efficacious substance in the treatment of metastatic breast cancer. Chronic administration of this compound is associated with the development of dose-dependent cardiotoxicity. This side effect is the most important limiting factor for the unrestricted use of this drug. Over the past years several anthracycline analogues have been developed which appear to be as effective against metastatic breast cancer as the parent compound. Moreover, there is some slight evidence that these drugs show less cardiotoxic activity than adriamycin. However, on objective review of the common treatment schedules in current use or under trial at present, it must be concluded that not one fully satisfies the ideal criteria of a safe and practicable procedure which does not stress the patient and is universally effective.