Advances in Chemotherapy for Metastatic Breast Cancer

Despite many advances over the past few years in the adjuvant treatment of breast cancer, a significant number of patients develop metastatic disease. Furthermore, a small yet consistent percentage of women are diagnosed with de novo metastatic disease. Once the disease has spread outside the locoregional area of the breast and draining lymph nodes, it is considered incurable, historically with a median survival of two to three years. More recent analyses of outcomes with modern treatment regimens suggest an improvement in median survival, with patients occasionally living for a prolonged period of time with metastatic disease. Systemic therapy is the primary modality of treatment, given with the dual goals of prolongation of survival and palliation of symptomatology. Selection of agents, timing of initiation and discontinuation, and incorporation of novel therapies is both a science and an art. For many women, sequential use of appropriate therapy can translate into years of prolonged survival with preserved quality of life.