Systemic chemotherapy for metastatic breast cancer

作     者：Yannan Zhao Biyun Wang 

作者机构：Department of Medical OncologyFudan University Shanghai Cancer Center Department of OncologyShanghai Medical CollegeFudan University 

出 版 物：《Oncology and Translational Medicine》 (肿瘤学与转化医学（英文版）)

年 卷 期：2015年第1卷第5期

页      面：226-232页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：chemotherapy metastatic breast cancer (MBC) single-agent chemotherapy combination chemotherapy triple-negative breast cancer maintenance treatment 

摘      要：Breast cancer is the leading cause of cancer among women worldwide and the most common cancer in China. Many factors influence the treatment strategy for metastatic breast cancer （MBC）. Chemotherapy should be administered to patients with hormone receptor-negative tumors, symptomatic visceral metasta- sis, and a short disease-free interval. Sequential single-agent chemotherapy has similar efficacy as combi- nation agents in terms of overall survival and quality of life. Anthracyclines are the cornerstone of first-line treatment for MBC, and taxanes represent the second treatment option after resistance. When progression or intolerable toxicity occurs after optimal treatment, the alternative treatments include capecitabine, vinorel- bine, and gemcitabine. Ixabepilone and eribulin are relatively new effective single agents. A combination of cytotoxic agents for patients with rapid clinical progression can further improve the overall response rate and time to progression compared to single-agent treatment. For patients with MBC who were pretreated with anthracyclines in the neoadjuvant/adjuvant setting, a taxane-containing regimen such as docetaxel plus capecitabine or gemcitabine plus paclitaxel should be administered. Platinum-based therapies such as cisplatin or carboplatin have a role in the treatment of triple-negative breast cancer. Meanwhile, the efficacy of the addition of targeted drugs such as iniparib, bevacizumab, and catuximab to chemotherapy remains unproven. Maintenance chemotherapy is routinely recommended in clinical practice at present. Patients who were previously treated with paclitaxel and gemcitabine have better progression-free and overall sur- vival with maintenance chemotherapy according to a Korean phase III clinical trial. Sequential maintenance treatment with capecitabine monotherapy after capecitabine-based combination chemotherapy （X-based X） appears favorable based on a series of domestic studies.