First-line treatment of metastatic breast cancer

Although metastatic breast cancer is an incurable disease, chemotherapy has had an impact on survival since the use of anthracycline drugs has become widespread. The optimal time for chemotherapeutic intervention for disseminated disease is in the first-line setting, but optimal treatments vary amongst patients, and the treatment must be chosen after consideration of the characteristics of the patient and the disease. Amongst the new drugs which have been used in the treatment of metastatic breast cancer, vinorelbine and the taxoids, docetaxel (Taxotere) and paclitaxel (Taxol), challenge monotherapy with anthracycline drugs, and even combination therapies, with regard to the response rate obtainable. In five multicentre phase II trials, the response rate to docetaxel, 75 or 100 mg/m2, given intravenously over 1 hour every 3 weeks, varied from 38 to 68%, with a median survival of 16.4 months across all studies. Good performance status and treatment with the higher dose improved response rates, though these effects were not statistically significant. Docetaxel has proved to be a highly active monotherapy for metastatic breast cancer in the first-line setting.