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Treatment of Metastatic Breast Cancer: Chemotherapy

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Abstract

There is no prespecified treatment algorithm for patients with metastatic breast cancer and treatment is tailored to each patient’s tumor biology as well as tolerance of side effects. Comorbidities, receptor status, and sites of metastasis are all taken into account when devising a treatment plan for each patient. Anthracyclines and taxanes continue to remain at the core of all treatment plans and both are equally efficacious in patients with metastatic breast cancer. The management of metastatic breast cancer aims at prolonging survival while maintaining quality of life.

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References

  1. Greenberg PA, Hortobagyi GN, Smith TL, Ziegler LD, Frye DK, Buzdar AU. Long-term follow-up of patients with complete remission following combination chemotherapy for metastatic breast cancer. J Clin Oncol. 1996;14(8):2197–205.

    CAS  PubMed  Google Scholar 

  2. American Cancer Society. Breast cancer facts and figures 2007–2008. Atlanta: American Cancer Society; 2009.

    Google Scholar 

  3. Osborne CK, Yochmowitz MG, Knight 3rd WA, McGuire WL. The value of estrogen and progesterone receptors in the treatment of breast cancer. Cancer. 1980;46(12 Suppl):2884–8.

    Article  CAS  PubMed  Google Scholar 

  4. Carrick S, Parker S, Thornton CE, Ghersi D, Simes J, Wilcken N. Single agent versus combination chemotherapy for metastatic breast cancer. Cochrane Database Syst Rev. 2009;(2):CD003372.

    Google Scholar 

  5. Albain KS, Nag SM, Calderillo-Ruiz G, Jordaan JP, Llombart AC, Pluzanska A, et al. Gemcitabine plus Paclitaxel versus Paclitaxel monotherapy in patients with metastatic breast cancer and prior anthracycline treatment. J Clin Oncol. 2008;26(24):3950–7.

    Article  PubMed  Google Scholar 

  6. Dear RF, McGeechan K, Jenkins MC, Barratt A, Tattersall MH, Wilcken N. Combination versus sequential single agent chemotherapy for metastatic breast cancer. Cochrane Database Syst Rev. 2013;(12):CD008792.

    Google Scholar 

  7. Hortobagyi GN, Smith TL, Legha SS, Swenerton KD, Gehan EA, Yap HY, et al. Multivariate analysis of prognostic factors in metastatic breast cancer. J Clin Oncol. 1983;1(12):776–86.

    CAS  PubMed  Google Scholar 

  8. Barrios CH, Sampaio C, Vinholes J, Caponero R. What is the role of chemotherapy in estrogen receptor-positive, advanced breast cancer? Ann Oncol. 2009;20(7):1157–62.

    Article  CAS  PubMed  Google Scholar 

  9. Park YH, Jung KH, Im SA, Sohn JH, Ro J, Ahn JH, et al. Phase III, multicenter, randomized trial of maintenance chemotherapy versus observation in patients with metastatic breast cancer after achieving disease control with six cycles of gemcitabine plus paclitaxel as first-line chemotherapy: KCSG-BR07-02. J Clin Oncol. 2013;31(14):1732–9.

    Article  CAS  PubMed  Google Scholar 

  10. Valero V, Jones SE, Von Hoff DD, Booser DJ, Mennel RG, Ravdin PM, et al. A phase II study of docetaxel in patients with paclitaxel-resistant metastatic breast cancer. J Clin Oncol. 1998;16(10):3362–8.

    CAS  PubMed  Google Scholar 

  11. Kantarajan HM, Wolff RA, Koller C. The MD Anderson manual of clinical oncology. 2nd ed. New York: McGraw-Hill; 2011.

    Google Scholar 

  12. Sledge GW, Neuberg D, Bernardo P, Ingle JN, Martino S, Rowinsky EK, Wood WC. Phase III trial of doxorubicin, paclitaxel and the combination of doxorubicin and paclitaxel as front-line chemotherapy for metastatic breast cancer: an Intergroup trial (E1193). J Clin Oncol. 2003;21(4):588–92.

    Article  PubMed  Google Scholar 

  13. Mauri D, Kamposioras K, Tsali L, Bristianou M, Valachis A, Karathanasi I, et al. Overall survival benefit for weekly vs. three-weekly taxanes regimens in advanced breast cancer: a meta-analysis. Cancer Treat Rev. 2010;36(1):69–74.

    Article  CAS  PubMed  Google Scholar 

  14. Winer EP, Berry DA, Woolf S, Duggan D, Kornblith A, Harris LN, et al. Failure of higher-dose paclitaxel to improve outcome in patients with metastatic breast cancer; cancer and leukemia group B trial 9342. J Clin Oncol. 2004;22(11):2061–8.

    Article  CAS  PubMed  Google Scholar 

  15. Sparano JA, Wang M, Martino S, Jones V, Perez EA, Saphner T, et al. Weekly paclitaxel in the adjuvant treatment of breast cancer. N Engl J Med. 2008;358(16):1663–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Jones S, Erban J, Overmoyer B, et al. Randomized phase III study of docetaxel compared with paclitaxel in metastatic breast cancer. J Clin Oncol. 2005;23(24):5542–51.

    Article  CAS  PubMed  Google Scholar 

  17. Rugo HS, Barry WT, Moreno-Aspitia A. CALGB 40502/NCCTG N063H: randomized phase III trial of weekly paclitaxel (P) compared to weekly nanoparticle albumin bound nab-paclitaxel (NP) or ixabepilone (Ix) with or without bevacizumab (B) as first-line therapy for locally recurrent or metastatic breast cancer (MBC). J Clin Oncol. 2012;30(suppl; abstr CRA1002).

    Google Scholar 

  18. Yu KD, Huang S, Zhang JX, Liu GY, Shao ZM. Association between delayed initiation of adjuvant CMF or anthracycline-based chemotherapy and survival in breast cancer: a systematic review and meta-analysis. BMC Cancer. 2013;13:240.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Falkson G, Tormey DC, Carey P, Witte R, Falkson HC. Long-term survival of patients treated with combination chemotherapy for metastatic breast cancer. Eur J Cancer. 1991;27(8):973–7.

    Article  CAS  PubMed  Google Scholar 

  20. Brunton L, Lazo J, Parker K. Goodman and Gilman’s, the pharmacological basis or therapeutics. New York: McGraw-Hill; 2012.

    Google Scholar 

  21. Weiss RB. The anthracyclines: will we ever find a better doxorubicin? Semi Oncol. 1992;19:670–86.

    CAS  Google Scholar 

  22. O’Brien ME, Wigler N, Inbar M, Rosso R, Grischke E, Santoro A, et al. Reduced cardiotoxicity and comparable efficacy in a phase III trial of pegylated liposomal doxorubicin HCl (CAELYX/Doxil) versus conventional doxorubicin for first-line treatment of metastatic breast cancer. Ann Oncol. 2004;15(3):440–9.

    Article  PubMed  Google Scholar 

  23. Piccart-Gebhart MJ, Burzykowski T, Buyse M, Sledge G, Carmichael J, Lück HJ, et al. Taxanes alone or in combination with anthracyclines as first-line therapy of patients with metastatic breast cancer. J Clin Oncol. 2008;26(12):1980–6.

    Article  CAS  PubMed  Google Scholar 

  24. Singletary SE, Robb GL, Hortobagyi GN. Advanced therapy of breast disease. BC Decker: Hamilton, Ontario; 2004.

    Google Scholar 

  25. Bachelot T, Romieu G, Campone M, Diéras V, Cropet C, Dalenc F, et al. Lapatinib plus capecitabine in patients with previously untreated brain metastases from HER2-positive metastatic breast cancer (LANDSCAPE): a single-group phase 2 study. Lancet Oncol. 2013;14(1):64–71.

    Article  CAS  PubMed  Google Scholar 

  26. Talbot DC, Moiseyenko V, Van Belle S, O’Reilly SM, Alba Conejo E, Ackland S, et al. Randomised phase II trial comparing oral capecitabine (Xeloda) with Paclitaxel in patients with metastatic/advanced breast cancer pretreated with anthracyclines. Br J Cancer. 2002;86(9):1367–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Blum JL, Jones SE, Buzdar AU, LoRusso PM, Kuter I, Vogel C, et al. Multicenter phase II study of capecitabine in paclitaxel-refractory metastatic breast cancer. J Clin Oncol. 1999;17(2):485–93.

    CAS  PubMed  Google Scholar 

  28. Fumoleau P, Largillier R, Clippe C, Dièras V, Orfeuvre H, Lesimple T, et al. Multicentre, phase II study evaluating capecitabine monotherapy in patients with anthracycline and taxane pretreated metastatic breast cancer. Eur J Cancer. 2004;40(4):536–42.

    Article  CAS  PubMed  Google Scholar 

  29. O’Shaughnessy JA, Blum J, Moiseyenko V, Jones SE, Miles D, Bell D, et al. Randomized, open-label, phase II trial of oral capecitabine (Xeloda) vs. a reference arm of intravenous CMF (cyclophosphamide, methotrexate and 5-fluorouracil) as first-line therapy for advanced/metastatic breast cancer. Ann Oncol. 2001;12(9):1247–54.

    Article  Google Scholar 

  30. O’Shaughnessy J, Miles D, Vukelja S, Moiseyenko V, Ayoub JP, Cervantes G, et al. Superior survival with capecitabine plus docetaxel combination therapy in anthracycline-pretreated patients with advanced breast cancer: phase III trial results. J Clin Oncol. 2002;20(12):2812–23.

    Article  PubMed  Google Scholar 

  31. Blackstein M, Vogel CL, Ambinder R, Cowan J, Iglesias J, Melemed A. Gemcitabine as first-line therapy in patients with metastatic breast cancer: a phase II trial. Oncology. 2002;62(1):2–8.

    Article  CAS  PubMed  Google Scholar 

  32. Carmichael J, Possinger K, Phillip P, Beykirch M, Kerr H, Walling J, Harris AL. Advanced breast cancer: a phase II trial with gemcitabine. J Clin Oncol. 1995;13(11):2731–6.

    CAS  PubMed  Google Scholar 

  33. Rha SY, Moon YH, Jeung HC, Kim YT, Sohn JH, Yang WI, et al. Gemcitabine monotherapy as salvage chemotherapy in heavily pretreated metastatic breast cancer. Breast Cancer Res Treat. 2005;90(3):215–21.

    Article  CAS  PubMed  Google Scholar 

  34. Feher O, Vodvarka P, Jassem J, Morack G, Advani SH, Khoo KS, et al. First-line gemcitabine versus epirubicin in postmenopausal women aged 60 or older with metastatic breast cancer: a multicenter, randomized, phase III study. Ann Oncol. 2005;16(6):899–908.

    Article  CAS  PubMed  Google Scholar 

  35. Perez EA, Lerzo G, Pivot X, Thomas E, Vahdat L, Bosserman L, et al. Efficacy and safety of ixabepilone (BMS-247550) in a phase II study of patients with advanced breast cancer resistant to an anthracycline, a taxane and capecitabine. J Clin Oncol. 2007;25(23):3407–14.

    Article  CAS  PubMed  Google Scholar 

  36. Canobbio L, Boccardo F, Pastorino G, Brema F, Martini C, Resasco M, Santi L. Phase-II study of Navelbine in advanced breast cancer. Semin Oncol. 1989;16(2 Suppl 4):33–6.

    CAS  PubMed  Google Scholar 

  37. Zelek L, Barthier S, Riofrio M, Fizazi K, Rixe O, Delord JP, et al. Weekly vinorelbine is an effective palliative regimen after failure with anthracyclines and taxanes in metastatic breast carcinoma. Cancer. 2001;92(9):2267–72.

    Article  CAS  PubMed  Google Scholar 

  38. Vogel C, O’Rourke M, Winer E, Hochster H, Chang A, Adamkiewicz B, et al. Vinorelbine as first-line chemotherapy for advanced breast cancer in women 60 years of age or older. Ann Oncol. 1999;10(4):397–402.

    Article  CAS  PubMed  Google Scholar 

  39. Cortes J, O’Shaughnessy J, Loesch D, Blum JL, Vahdat LT, Petrakova K, et al. Eribulin monotherapy versus treatment of physician’s choice in patients with metastatic breast cancer (EMBRACE): a phase 3 open-label randomized study. Lancet. 2011;377(9769):914–23.

    Article  CAS  PubMed  Google Scholar 

  40. Kaufman PA, Awada A, Twelves C, Yelle L, Perez EA, Velikova G, et al. Phase III open-label randomized study of eribulin mesylate versus capecitabine in patients with metastatic breast cancer previously treated with an anthracycline and a taxane. J Clin Oncol. 2015;33(6):594–601.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Licchetta A, Correale P, Migali C, Remondo C, Francini E, Pascucci A, et al. Oral metronomic chemo-hormonal-therapy of metastatic breast cancer with cyclophosphamide and megestrol acetate. J Chemother. 2010;22(3):201–4.

    Article  CAS  PubMed  Google Scholar 

  42. Lerma E, Nissenson A, Berns J. Acute renal failure from therapeutic agents from current diagnosis and treatment: nephrology and hypertension. Curr Diagn Treat: Nephrol Hypertens. New York: McGraw-Hill; 2009.

    Google Scholar 

  43. Martin M. Platinum compounds in the treatment of advanced breast cancer. Clin Breast Cancer. 2001;2(3):190–208; discussion 209.

    Article  CAS  PubMed  Google Scholar 

  44. Isakoff SJ, Mayer EL, He L, Traina TA, Carey LA, Krag KJ, et al. TBCRC009: a multicenter phase II clinical trial of platinum monotherapy with biomarker assessment in metastatic, triple-negative breast cancer. J Clin Oncol. 2015;33(17):1902–9.

    Article  CAS  PubMed  Google Scholar 

  45. Watkins J, Weekes D, Shah V, Gazinska P, Joshi S, Sidhu B, et al. Genomic complexity profiling reveals that HORMAD1 contributes to homologous recombination deficiency in triple-negative breast cancers. Cancer Discov. 2015;5(5):488–505.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Tutt A, Ellis P, Kilburn L, Gilett C, Pinder S, Abraham J, et al. TNT: a randomized phase III trial of carboplatin compared with docetaxel for patients with metastatic or recurrent locally advanced triple negative or BRCA 1/2 breast cancer. Abstract from San Antonio Breast Cancer Symposium. San Antonio: TX; 2014.

    Google Scholar 

  47. Gradishar WJ, Anderson BO, et al. NCCN guidelines in oncology: breast cancer. Version 2.2015. J Natl Compr Canc Netw. 2015;13:448–75. http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf

  48. Perez EA, Vogel CL, Irwin DH, Kirshner JJ, Patel R. Multicenter phase II trial of weekly paclitaxel in women with metastatic breast cancer. J Clin Oncol 2001;19:4216–23.

    CAS  PubMed  Google Scholar 

  49. Burris HA 3rd. Single-agent docetaxel (Taxotere) in randomized phase III trials. Semin Oncol. 1999;26:1–6.

    CAS  PubMed  Google Scholar 

  50. Gradishar WJ, Tjulandin S, Davidson N, Shaw H, Desai N, Bhar P, et al. Phase III trial of nanoparticle albumin-bound paclitaxel compared with polyethylated castor oil-based paclitaxel in women with breast cancer. J Clin Oncol. 2005;23:7794–803.

    Article  CAS  PubMed  Google Scholar 

  51. Mavroudis D, Papakotoulas P, Ardavanis A, Syrigos K, Kakolyris S, Ziras N, et al. Breast Cancer Investigators of the Hellenic Oncology Research Group. Randomized phase III trial comparing docetaxel plus epirubicin versus docetaxel plus capecitabine as first-line treatment in women with advanced breast cancer. Ann Oncol. 2010;21:48–54.

    Article  CAS  PubMed  Google Scholar 

  52. Miller K, Wang M, Gralow J, Dickler M, Cobleigh M, Perez EA, et al. Paclitaxel plus Bevacizumab versus Paclitaxel Alone for Metastatic Breast Cancer. N Engl J Med. 2007;357:2666–76.

    Article  CAS  PubMed  Google Scholar 

  53. Norris B, Pritchard KI, James K, Myles J, Bennett K, Marlin S, et al. Phase III comparative study of vinorelbine combined with doxorubicin versus doxorubicin alone in disseminated metastatic/recurrent breast cancer: National Cancer Institute of Canada Clinical Trials Group Study MA8. J Clin Oncol. 2000;18:2385–2394.

    CAS  PubMed  Google Scholar 

  54. Andersson M, Daugaard S, von der Maase H, Mouridsen HT. Doxorubicin versus mitomycin versus doxorubicin plus mitomycin in advanced breast cancer: a randomized study. Cancer Treat Rep 1986; 70:1181.

    CAS  PubMed  Google Scholar 

  55. Keller AM, Mennel RG, Georgoulias VA, Nabholtz JM, Erazo A, Lluch A, et al. Randomized phase III trial of pegylated liposomal doxorubicin versus vinorelbine or mitomycin C plus vinblastine in women with taxane-refractory advanced breast cancer. J Clin Oncol 2004; 22:3893.

    Article  CAS  PubMed  Google Scholar 

  56. Joensuu H, Holli K, Heikkinen M, Suonio E, Aro AR, Hietanen P, Huovinen R. Combination chemotherapy versus single-agent therapy as first- and second-line treatment in metastatic breast cancer: a prospective randomized trial. J Clin Oncol 1998; 16:3720.

    CAS  PubMed  Google Scholar 

  57. Hortobagyi GN, Blumenschein GR, Tashima CK, Buzdar AU, Burgess MA, Livingston RB, et al. Ftorafur, adriamycin, cyclophosphamide and BCG in the treatment of metastatic breast cancer. Cancer. 1979;44:398–405.

    Article  CAS  PubMed  Google Scholar 

  58. Nabholtz JM, Falkson C, Campos D, Szanto J, Martin M, Chan S, et al. Docetaxel and doxorubicin compared with doxorubicin and cyclophosphamide as first-line chemotherapy for metastatic breast cancer: results of a randomized, multicenter, phase III trial. J Clin Oncol 2003;21:968.

    Article  CAS  PubMed  Google Scholar 

  59. Langley RE, Carmichael J, Jones AL, Cameron DA, Qian W, Uscinska B, et al. Phase III trial of epirubicin plus paclitaxel compared with epirubicin plus cyclophosphamide as first-line chemotherapy for metastatic breast cancer: United Kingdom National Cancer Research Institute trial AB01. J Clin Oncol. 2005;23:8322–30.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Shannon L. Puhalla MD .

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Bhattacharya, S., Puhalla, S.L. (2016). Treatment of Metastatic Breast Cancer: Chemotherapy. In: Aydiner, A., İgci, A., Soran, A. (eds) Breast Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-26012-9_32

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  • DOI: https://doi.org/10.1007/978-3-319-26012-9_32

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