Chemotherapy in Advanced Breast Cancer

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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.

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