Management of breast cancer: status and future trends

Abstract

Metastatic breast cancer continues to be a challenge for the clinician. Heterogeneity of natural history and drug resistance have interfered with progress in treatment. Hormonal therapy is effective in 30% of patients, some of whom derive long-term benefit from sequential hormonal manipulations. Most patients have hormone-refractory tumors, and eventually all breast cancers become hormone resistant. Cytotoxic chemotherapy is the treatment of choice for these patients. Promising leads in recent clinical investigation include the development of dose-intensive therapies for induction or remission consolidation, biochemical modulation, development of new hormonal and cytotoxic agents, targeted therapy using immunologic or ligand-driven vehicles, and growth factor modulation. Among the encouraging clinical developments, the discovery of the taxanes represents an important step in improving the efficacy of cytotoxic therapy. Paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) produces objective regressions in 40% to 60% of patients with untreated or minimally treated metastatic breast cancer. The efficacy of this agent persists in patients with chemotherapy-refractory tumors, including those with anthracycline resistance. New paclitaxel-based combinations, especially those with doxorubicin, cisplatin, or vinorelbine, appear promising. This agent, alone or in combination, is also under evaluation in combined-modality strategies for early and advanced primary breast cancer.