Chemotherapy of advanced breast cancer

The treatment of clinically overt metastatic breast cancer, despite several treatment modalities (biological response modifiers, megatherapy with autologous bone marrow transplantation, growth factors, new agents, etc.) is in a static phase. In the decision-making one has to consider the patient's age, her menstrual state, the metastatic site, previous adjuvant and/or postoperative treatment modalities. Roughly there are two treatment forms, the hormonal and the cytostatic ones. Endocrine therapy should be given as follows: 1. only for low risk group, 2. gestagen or antiestrogen therapy is the choice for the first step, 3. if there is a progression in 3 months, the hormonal treatment should be changed to cytostatic combination, 4. if there is a progression beyond 3 months further hormonal therapy can be considered. The efficacy of endocrine therapy is 30%. In patients with advanced breast cancer chemotherapy provides a response rate of 30 to 60%, however total survival of the patients does not improve substantially. Doxorubicin containing regimens are more effective, however no response in total survival can be obtained. New plant alkaloids and altered treatment forms will probably influence survival. Taking all these into consideration one has to decide on the quality of life of the breast cancer patients.