Improving treatment for advanced breast cancer

Treatment for advanced breast cancer is not yet curative but aims to palliate the disease to make life as symptom free and as active for as long as possible with the minimum of adverse effects of treatment. The high prevalence and often long time course of the disease leads breast cancer to make major demands on health care resources. Radiotherapy is valuable for localized lesions, but more widespread disease relies on systemic treatment. Tamoxifen is the main agent for endocrine therapy, although aromatase inhibitors and progestogens are also important. Improvements in cytotoxic chemotherapy have come as much from methods to reduce toxicity as from new agents. Intensive chemotherapy with bone marrow support has not found a routine place in advanced breast cancer, but experience gained may have more application in the adjuvant treatment of high risk operable disease. Incorporation of quality of life measures is being increasingly recognized as essential for the proper evaluation of response to treatment. Although postoperative adjuvant systemic therapy now has an established place for early breast cancer, subsequent relapse responds less well to either endocrine or cytotoxic agents. Bone metastases are a major problem in advanced breast cancer, most of the damage being mediated by the stimulation of osteoclasts by tumour derived cytokines. Important advances in treatment have come from the use of bisphosphonates and beta emitting isotopes. Monitoring of bone metastases is enhanced by using biochemical parameters of response in addition to imaging techniques.