Changing Treatment Landscape in Metastatic Breast Cancer


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Twenty years ago, chemotherapies, such as methotrexate, cyclophosphamide, and doxorubicin, were the mainstays of breast cancer treatment, but there were limited chemotherapy options from which to select. Adam Brufsky, MD, notes that the only real targeted therapy two decades ago was tamoxifen. Today, aromatase inhibitors have come into the forefront and are now obtainable as generic formulations. Targeted agents, such as trastuzumab, pertuzumab, and lapatinib, are widely used in practice. The breadth of effective chemotherapeutic agents has expanded from essentially only anthracyclines to include capecitabine, ixabepilone, and taxanes, which now have generic options. New formulations of taxanes, such as nanoparticle paclitaxel, have been approved.

Brufsky observes that breast cancer treatment is now entering into an area of truly targeted therapy. With these new therapies came a shift in ways to approach disease management. When treating advanced breast cancer, similar to early-stage breast cancer, clinicians consider 3 different clinical syndromes, describes Harold Burstein, MD. Hormone-receptor-positive tumors are treated with anti-estrogen therapies, and HER2-directed therapies are given in HER2-driven breast cancers. Patients with triple-negative disease (tumors that lack estrogen and progesterone receptor as well as HER2 expression) rely heavily on chemotherapy.

Breast cancer patients today have more options, as clinicians construct new approaches in treatment. Burstein comments that the average patient with breast cancer will receive 4 or 5 lines of chemotherapy, and it is not unusual for patients to receive 10 lines of treatment. Brufsky notes that selecting the appropriate therapy for a given individual can be difficult. Oncologists are currently faced with the challenge of determining which of these broad variety of therapies, all of which are effective, should be applied to a particular patient situation.

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