Management of metastatic breast cancer

Abstract

Systemic treatment almost certainly prolongs the median survival of women with metastatic breast cancer, and it may prolong the survival of a small number of patients substantially. Even with conventional therapy, 10% or more patients may live into the second decade after recurrence. However, the disease cannot be eradicated, and the primary goal of treatment remains palliation and improvement of the quality of life. Because of the great variability in the pattern and course of the disease from one patient to another, therapy should be selected judiciously to maximize response and minimize toxicity. In some clinical situations, such as pathologic fractures and brain metastases, local therapies alone, such as surgery or irradiation, are the treatments of choice. Patients who will respond to endocrine therapy are well defined, and all patients with the characteristics of an endocrine responder deserve a chance at palliation with this modality alone because of its limited toxicity. A number of new forms of endocrine therapy with more specific targets at estrogen and progesterone receptor sites are now in clinical trials. When used appropriately, chemotherapy significantly improves patient quality of life despite its toxicity. No drug combinations, schedules, or doses have been shown to prolong survival or provide better net palliation than classic CMF (oral cyclophosphamide with intravenous methotrexate and 5-fluorouracil) or CAF (intravenous cyclophosphamide, doxorubicin, and 5-fluorouracil). Treatment with these combinations in excess of 6 to 9 months provides only marginal additional benefits and no survival advantage. The role of high dose chemotherapy with autologous bone marrow transplantation remains a promising area of investigation, but the available survival data are entirely compatible with the possibility that this modality will eventually prove inferior to conventional therapy. Many new cytotoxic agents with unique mechanisms of action are currently under investigation, including taxol, taxotere, Topotecan, and amonafide. Taxol may be the most promising therapy now available for patients whose disease has become refractory to doxorubicin. Biologic therapies using monoclonal antibodies against a specific oncogene or its product have entered clinical trials, and novel drug delivery systems using liposomes are under evaluation.

The predictive value of body protein for chemotherapy-induced toxicity

“…The cyclophosphamide, methotrexate, 5‐fluorouracil (CMF) combination chemotherapy regimen is one of the most widely used regimens in the treatment of patients with breast carcinoma 1, 2. It has well‐documented efficacy as an adjuvant treatment,3 and it has been show to be as effective as other combination chemotherapy regimes in prolonging survival and is a useful palliative treatment 3–6. Common toxicities reported include nausea and vomiting, alopecia, mucositis, and diarrhea, whereas dose limiting toxicity is myelosuppression 7–10…”

Metastatic Breast Cancer to the Common Bile Duct Presenting as Obstructive Jaundice

“…Hematogenous spread to the extrahepatic or CBD is rare. Twenty-seven cases of metastatic breast cancer to the bile ducts are reported in the literature, with 10 cases involving the extrahepatic duct, 6 cases involving extrahepatic lymph nodes with direct extension into the bile duct, 2 cases of ampulla of Vater with extension into the CBD, 3 undetermined cases and 6 cases of CBD involvement [ 1 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ].…”

“…It is one of the main causes of cancer-related deaths seen in women, with only lung cancer having a higher mortality rate [ 2 ]. One-third of women with breast cancer will develop metastatic spread and 10%percnt; of these patients will have metastatic spread at the time of diagnosis [ 3 ]. Metastatic breast cancer is typically identified in the brain, bones, lymph nodes, lungs and liver.…”

Fernmetastasen-Chirurgie beim Mammakarzinom: Ist sie sinnvoll?

“…Das Gesamtüberleben nach diagnostizierter ossärer Metastasierung liegt bei 2±3 Jahren, wobei 10 % der Pat. >10 Jahre leben [14,15]. Patienten mit derartigem Langzeitüberleben haben zumeist solitäre, auf ein Organsystem beschränkte Fernmetastasen und sind vorab mit Systemtherapien intermittierend oder kontinuierlich behandelt worden.…”