Challenges in the Management of Metastatic Breast Cancer

Abstract

Breast cancer is the most common cancer in women in the United States. About 6% of newly diagnosed breast cancer cases present with metastatic disease, and one-third of women diagnosed with earlier stage breast cancer develop metastatic disease. Management of metastatic breast cancer (MBC) continues to be challenging, and MBC remains essentially an incurable disease. Treatment of MBC is individualized for each patient, and it is often based on patient’s preferences, comorbidities, performance status, prognostic factors, menopausal status, and prior history of treatments. Risk assessment is the first step in the management of MBC. Factors that can affect the prognosis (hormone receptor status, HER-2 expression status, disease-free interval, tumor burden, site of metastasis, and vital organ involvement) are considered before start of the treatments. Women with hormone responsive disease and stable bony metastasis are often treated with hormonal therapies and bisphosphonates. Women with hormone-unresponsive disease or fast-growing tumors are treated with systemic chemotherapy with or without a targeted therapy agent. Metastasis to the brain, spinal cord compression, pleural effusion, hypercalcemia, and pancytopenia secondary to bone marrow infiltration are common complications of MBC, and the management of each complication will be briefly discussed. Future research to identify molecular prognostic markers and to evaluate various strategies for optimal management of MBC is needed.