Chemotherapy for advanced breast cancer: a current perspective

The systemic management of patients with hormone-refractory breast cancer metastatic to sites beyond regional axillary lymph nodes is classically characterized by the thoughtful, step-wise administration of cytotoxic chemotherapeutic agents. At various junctures in the continuum of care, a patient/physician analysis of the potential risks and benefits of chemotherapy may lead to the decision to proceed with subsequent systemic therapy, to consider an investigational strategy, or to opt for supportive care alone. The emergence of new active agents such as the taxanes has provided a valuable alternative option for such patients. While other cytotoxic agents in development may ultimately prove useful in the management of stage IV breast cancer, including some with novel antineoplastic mechanisms, there is evidence for optimism that the ability to perturb autocrine and paracrine growth factor pathways (eg, with monoclonal antibodies) may afford a viable alternative systemic approach, perhaps with a greater therapeutic index than "conventional" agents. Throughout the process of drug development, an increasing focus on the impact of new systemic regimens on quality of life, and costs associated with the palliative care of metastatic breast cancer should optimize the care of women with this disease.