(pharm)* mortality in women 1 . Approximately 6% of women with breast cancer are metastatic at diagnosis 2 , a rate that will account for just over 1300 new breast cancer diagnoses in Canadian women in 2007 1,2 .Unfortunately, many women with early breast cancer will be diagnosed with a metastatic relapse in the years following treatment with locoregional and systemic adjuvant therapies. The goals of treatment in metastatic breast cancer include prolongation of survival, symptom control, and maintenance of quality of life. In Alberta, chemotherapy for breast cancer is prescribed at tertiary, associate, and community cancer clinics, all of which are affiliated with the Alberta Cancer Board.The literature on taxanes and breast cancer has been growing exponentially since the mid-1990s. In the absence of an evidence-based provincial guideline, regional variability in taxane prescription is to be expected. The objective of creating a provincial guideline on the optimal use of taxanes in the management of metastatic breast cancer is to promote evidence-based consistency in practice and hence equitable patient access to appropriate therapies. Guidelines for taxane use in the management of metastatic breast cancer have previously been published. The guidelines published here were developed by the Alberta Cancer Board Provincial Breast Tumour Group Guideline Panel by systematically adapting the recommendations of others and by creating de novo recommendations to account for recent evidence.
APPROACH TO GUIDELINE DEVELOPMENT
ObjectiveThe objective was to determine the optimal clinical use of taxanes in the management of metastatic breast cancer.
Key Clinical QuestionsWhich taxane regimens can be offered to an-• thracycline-naïve patients with metastatic breast
ABSTRACTThe role of taxanes in the treatment of breast cancer is becoming increasingly important. In clinical practice, the taxanes are now standard therapy in both early-stage and metastatic breast cancer. Since the 1990s, multiple randomized clinical trials have been evaluating the efficacy of taxanes in the treatment of metastatic breast cancer. These trials have included treatment with taxanes alone or in combination with other chemotherapeutic agents. Pre-existing published guidelines for the use of taxanes in the management of metastatic breast cancer are available. The mandate of the Alberta Cancer Board Provincial Breast Tumour Group Guideline Panel was to consider and adapt the recommendations of the existing guidelines and to develop de novo guidelines to account for current evidence. For this task, the panel used the adapte process, which is a systematic process of guideline adaptation developed by the adapte Collaboration. The recommendations formulated by the panel included the identification of taxane regimens that could be offered in anthracycline-naïve patients, anthracycline-pretreated or -resistant patients, and patients overexpressing the human epidermal growth factor receptor 2. Potential toxicities and benefits in terms of time to progression, p...