Systemic treatment for metastatic breast cancer: Selection of chemotherapy regimen

INTRODUCTION

Although metastatic breast cancer is unlikely to be cured, meaningful improvements in survival have been seen, coincident with the introduction of newer systemic therapies [1-3]. Median overall survival approaches two years, with a range from a few months to many years [4].

The selection of a therapeutic strategy depends upon both tumor biology and clinical factors, with the goal being a tailored approach. Although a subset of patients with oligometastatic disease may benefit from an intensified locoregional approach, most patients with metastatic breast cancer receive systemic medical therapy, consisting of chemotherapy, endocrine therapy, and/or biologic therapies, and supportive care measures [5,6].

Principles in selecting a chemotherapy regimen are presented here. Active single agent and combination chemotherapy regimens, including biologic therapies, are discussed separately, as are endocrine therapy and supportive care.

• (See "Systemic treatment for metastatic breast cancer: General principles".)
• (See "Treatment approach to metastatic hormone receptor-positive breast cancer: Endocrine therapy".)
• (See "Systemic treatment for metastatic breast cancer: Combination chemotherapy".)
• (See "Systemic treatment for metastatic breast cancer: Single agent chemotherapy".)
• (See "Systemic treatment for metastatic breast cancer: Molecular targeted therapy".)
• (See "Treatment of metastatic breast cancer in older women".)

GENERAL PRINCIPLES

The selection of chemotherapy for metastatic breast cancer must be individualized and balance disease-related factors, such as disease sites, apparent progression rate, and hormone receptor and human epidermal growth factor receptor 2 (HER2) status, with patient factors, such as comorbidities and general health. Response and resistance to prior chemotherapy, as well as prior therapy-related toxicities, should also be taken into account.