Treatment Choices for Second-Line Chemotherapy of Metastatic Breast Cancer

Abstract

A vast array of new cytotoxic drugs has opened the possibility for second- and third-line treatment of patients with metastatic breast cancer pretreated by anthracyclines and/or taxanes. These new drugs include capecitabine, gemcitabine, liposomal doxorubicin, vinorelbine and even some of the older agents administered in weekly schedules. These drugs can be administered as either monotherapy or polychemotherapy mainly consisting of double-drug regimens. Phase II studies of these drugs have produced such favorable data that patients with metastatic breast cancer pretreated with anthracyclines and/or taxanes can safely be offered either of these agents and phase III studies are definitely warranted in this patient population. Currently, data from one phase III trial are available in which docetaxel plus capecitabine was found to result in significantly prolonged time to disease progression and overall survival as compared to docetaxel alone in anthracycline-pretreated patients with advanced breast cancer. No golden standard has emerged, however, for patients pretreated with taxanes and anthracyclines further underlining the need of testing various cytotoxic compounds either as monotherapy or in combination with other cytotoxic drugs in this setting.