[Chemotherapy in the management of breast cancer]

Thirty-five years after its first use in breast cancer, chemotherapy has become a major management tool. In locally advanced and inflammatory forms, chemotherapy is administered preoperatively giving a 5-year survival rate of 50 to 70%. As an adjuvant, both for N+ and N-forms, and both before and after menopause, chemotherapy improves overall and relapse-free survival rate. Chronicity is thus possible in metastatic cases with objective responses above 70% and important progress in patient comfort. In addition to alkylizing agents, 5-fluoro-uracil, anthracyclines and methotrexate used in the traditional combinations, new cytostatic agents, vinorelbine and taxoid agents, now in phase I and phase II trials have demonstrated their effectiveness in breast cancer. Medullar growth factors, and autografting with bone marrow and more recently circulating stem cells have made it possible to intensify the doses (although to what precise level have yet to be established.