[Treatment strategy for recurrent breast cancer]

In recent years, many kinds of efficacious modalities have been available for the treatment of recurrent breast cancer. Endocrine therapy is essentially the treatment of choice for both premenopausal and postmenopausal patients. The recommended sequence of endocrine therapies is described as follows: In premenopausal women, ovarian ablation (LH-RH agonists) is considered the first-line therapy, with tamoxifen (TAM) and aromatase inhibitors (AI) as the second-line alternatives. In postmenopausal women, the recommended first and second-line therapy is TAM and AI, respectively. Medroxyprogesterone acetate (MPA) should be used as the third-line agent, irrespective of menopausal status. However, efficacy of combinations such as LH-RH agonist plus TAM for premenopausal women and TAM plus AI for the postmenopausals is still uncertain. Patients with rapidly progressing and/or endocrine-resistant tumor should be treated with anthracycline containing regimen such as CAF (cyclophosphamide, adriamycin, 5-fluorouracil). As for the palliative modality, chemotherapy (CAF, doxifluidine) combined with MPA has resulted in improved QOL.