Chemotherapy in Advanced Breast Cancer

Panelists: William J. Gradishar, MD, Northwestern;Joyce O’Shaughnessy, MD, Texas Oncology;
Christy A. Russell, MD, USC Norris; Debu Tripathy, MD, USC Norris;
Linda Vahdat, MD, Weill Cornell Medical College
Published Online: Wednesday, November 28, 2012
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Determining the optimal sequence and time to administer chemotherapy is a challenge facing many physicians who treat breast cancer. Chemotherapies are approved in all subtypes of advanced breast cancer and are currently the only option available to treat triple-negative breast cancer (TNBC).

The method for choosing the best chemotherapy is a balancing act between efficacy and toxicity, states Linda T. Vahdat, MD. If a clear survival advantage has not been demonstrated with a particular sequence, Vahdat will administer agents that do not cause alopecia or other side effects as a first-line option. In general, capecitabine is used most frequently, except in TNBC where several trials have shown it is less effective. In the late-line setting, eribulin mesylate (Halaven) has demonstrated a survival advantage and is well tolerated. The decision to administer a monotherapy or a combination should be based on treatment goals, Vahdat notes. If a response is needed quickly, a combination may be the best option.

Moderator, Debu Tripathy, MD, mentions the phase III CALGB 40502 study that seemed to indicate that weekly paclitaxel was a better choice than nab-paclitaxel and ixabepilone in chemotherapy-naïve metastatic breast cancer. These results surprised Vahdat who expected that ixabepilone would perform better, based on her clinical experience. Joyce A. O’Shaughnessy, MD, adds that the weekly dose of ixabepilone used in the CALGB study was inferior to an every three-week schedule, which may have impacted its efficacy.
View More From This Discussion
Episode 1 Improving the Management of Metastatic Breast Cancer, Part I
Episode 2 Management of Metastatic Breast Cancer, Part II
Episode 3 Chemotherapy in Advanced Breast Cancer
Episode 4 Emerging Therapies in Metastatic Breast Cancer
Episode 5 Managing Skeletal-Related Events in Breast Cancer, Part I
Episode 6 Managing Skeletal-Related Events in Breast Cancer, Part II
Episode 7 Molecular and Personalized Medicine in Breast Cancer
Expert Panelists
Debu Tripathy

Debu Tripathy, MD

Co-Leader, Women's Cancer Program
USC Norris Comprehensive Cancer Center
University of Southern California
Los Angeles, California

William J. Gradishar, MD

Director, Maggie Daley Center
for Women's Cancer Care
Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois

Joyce A. O’Shaughnessy, MD

Co-Director, Breast Cancer Research
Baylor Charles A. Sammons Cancer Center
Texas Oncology, PA/US Oncology,
Dallas, Texas

Christy A. Russell, MD

Co-Director, USC Norris Breast Center
USC Norris Comprehensive Cancer Center
University of Southern California
Los Angeles, California

Linda T. Vahdat, MD

Director, Breast Cancer Research Program
Head, Solid Tumor Service
Weill Cornell Medical College
New York, New York
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