The role of docetaxel in improving treatment outcomes in advanced breast cancer

Abstract

ADVANCED BREAST cancer is a major public health problem. Although most women in developed countries who develop breast cancer are diagnosed when the disease is operable, locally advanced or disseminated tumours account for more than half of new cases in developing countries. Despite optimal multidisciplinary management, approximately half of all patients with operable disease ultimately relapse. Many patients with metastatic breast disease have a prolonged chronic illness, with periods of reactivation and remission requiring multiple therapeutic approaches. This places a heavy burden on healthcare resources. Although the past two to three decades have seen many advances in both endocrine and chemotherapeutic treatments, these developments have largely resulted in a reduction in toxicity rather than improved control of the disease and so advanced breast cancer remains incurable. Certain features such as liver metastases and resistance to chemotherapy contribute further to the poor prognoses of these patients. Thus, innovative approaches to treatment are urgently required. The role of the taxoid docetaxel (Taxoterem) in the treatment of advanced breast cancer was discussed at a satellite symposium entitled ‘Improving Treatment Outcomes in Advanced Breast Cancer’, which took place at the 7th EORTC Breast Cancer Working Conference in Bordeaux, France, in September 1996. The key messages emerging from the symposium concerned the definition of anthracycline resistance and the promising activity of docetaxel. Current definitions of anthracycline resistance differ widely. Clinical trials in which more stringent definitions are used when selecting patients with anthracycline-resistant tumours tend to show lower response rates to the anticancer agents being evaluated than do trials in which broader definitions are used. To interpret and compare the data from such trials and to be able to determine accurately which of these agents is the most effective, it is imperative that the definition of anthracycline resistance is consistent.