Abstract
Metastatic breast cancer (MBC) is unfortunately still considered incurable; treatment aims to prolong progression-free and overall survival, relieve disease symptoms, and maintain quality of life. Treatment can include endocrine therapy, radiotherapy, chemotherapy, bisphosphonates, and/or targeted therapy; which is used depends on the characteristics of the disease [e.g., hormone receptor status, disease site(s), and response to previous treatment] and the patient (age, comorbidity, and personal preferences). For most patients with hormone-receptor-positive tumors, the first choice of treatment is further endocrine therapy, but endocrine resistance is a common problem in advanced disease. Several novel anticancer agents have been developed with the aim of overcoming endocrine resistance, many of which target intracellular signaling pathways implicated in disease progression or resistance. Among these, inhibitors of growth factor receptor tyrosine kinases and of mammalian target of rapamycin have shown the most promise in clinical trials. Chemotherapy is the cornerstone of MBC treatment in most women. Important considerations when choosing chemotherapy include the choice of agents, and whether to use single-agent or combination therapy. Anthracyclines are one of the most active cytotoxic agents currently used for the treatment of breast cancer, and for many women, further anthracycline therapy at progression or relapse would be the preferred option. However, lifetime exposure to anthracyclines is limited by cumulative cardiotoxicity, which often prevents rechallenge in later lines of therapy. Newer anthracycline formulations have been developed with lower cardiotoxicity than the conventional anthracycline doxorubicin, but these agents still impair cardiac function, and have maximum recommended lifetime doses. Recently, the concomitant use of cardioprotective agents, such as dexrazoxane, has emerged as an effective approach to reducing the cardiotoxic effects of anthracyclines, thus permitting retreatment. Bisphosphonates, which are not associated with the acute toxicities of cytotoxic chemotherapy drugs, are the established standard of care for patients with metastatic bone disease, and have greatly improved outcomes over the last decade. The search is ongoing for novel agents that will, hopefully, bring a cure closer to reality.
Similar content being viewed by others
References
Chung CT, Carlson RW (2003) Goals and objectives in the management of metastatic breast cancer. Oncologist 8:514–520. doi:10.1634/theoncologist.8-6-514
Gennari A, Conte P, Rosso R et al (2005) Survival of metastatic breast carcinoma patients over a 20-year period: a retrospective analysis based on individual patient data from six consecutive studies. Cancer 104:1742–1750. doi:10.1002/cncr.21359
Beslija S, Bonneterre J, Burstein H et al (2007) Second consensus on medical treatment of metastatic breast cancer. Ann Oncol 18:215–225. doi:10.1093/annonc/mdl155
European School of Oncology (ESO)-MBC Task Force (2007) Metastatic breast cancer. Recommendations proposal from the European School of Oncology (ESO). MBC Task Force. Breast 16:9–10
Kataja VV, Colleoni M, Bergh J, ESMO Guidelines Task Force (2005) ESMO minimum clinical recommendations for diagnosis, treatment and follow-up of locally recurrent or metastatic breast cancer (MBC). Ann Oncol 16(Suppl 1):i10–i12. doi:10.1093/annonc/mdi816
Gligorov J, Luporsi E, Namer M, Serin D, for the Saint Paul de Vence Guidelines Task force (2007) Breast cancer recommendations for clinical practice. Oncologie 9:593–644. doi:10.1007/s10269-007-0753-7
Normanno N, Di Maio M, De Maio E et al (2005) Mechanisms of endocrine resistance and novel therapeutic strategies in breast cancer. Endocr Relat Cancer 12:721–747. doi:10.1677/erc.1.00857
Carrick S, Parker S, Wilcken N et al (2005) Single agent versus combination chemotherapy for metastatic breast cancer. Cochrane Database Syst Rev 2:CD003372
Jensen BV (2006) Cardiotoxic consequences of anthracycline-containing therapy in patients with breast cancer. Semin Oncol 33(3 suppl 8):S15–S21. doi:10.1053/j.seminoncol.2006.04.022
Rivera E (2003) Liposomal anthracyclines in metastatic breast cancer: clinical update. Oncologist 8(Suppl 2):3–9. doi:10.1634/theoncologist.8-suppl_2-3
Cvetkovic RS, Scott LJ (2005) Dexrazoxane: a review of its use for cardioprotection during anthracycline chemotherapy. Drugs 65:1005–1024. doi:10.2165/00003495-200565070-00008
Pavlakis N, Schmidt R, Stockler M (2005) Bisphosphonates for breast cancer. Cochrane Database Syst Rev 3:CD003474
Bonneterre J, Buzdar A, Nabholtz JM et al (2001) Anastrozole is superior to tamoxifen as first-line therapy in hormone receptor positive advanced breast carcinoma. Cancer 92:2247–2258. doi :10.1002/1097-0142(20011101)92:9<2247::AID-CNCR1570>3.0.CO;2-Y
Mouridsen H, Gershanovich M, Sun Y et al (2001) Superior efficacy of letrozole versus tamoxifen as first-line therapy for postmenopausal women with advanced breast cancer: results of a phase III study of the International Letrozole Breast Cancer Group. J Clin Oncol 19:2596–2606
Paridaens R, Therasse P, Dirix L et al (2004) First line hormonal treatment (HT) for metastatic breast cancer (MBC) with exemestane (E) or tamoxifen (T) in postmenopausal patients (pts)—a randomized phase III trial of the EORTC Breast Group. J Clin Oncol 22:14S Abstract 515
Buzdar AU, Jonat W, Howell A et al (1998) Anastrozole versus megestrol acetate in the treatment of postmenopausal women with advanced breast carcinoma: results of a survival update based on a combined analysis of data from two mature phase III trials. Arimidex Study Group. Cancer 83:1142–1152. doi :10.1002/(SICI)1097-0142(19980915)83:6<1142::AID-CNCR13>3.3.CO;2-7
Dombernowsky P, Smith I, Falkson G et al (1998) Letrozole, a new oral aromatase inhibitor for advanced breast cancer: double-blind randomized trial showing a dose effect and improved efficacy and tolerability compared with megestrol acetate. J Clin Oncol 16:453–461
Kaufmann M, Bajetta E, Dirix LY et al (2000) Exemestane is superior to megestrol acetate after tamoxifen failure in postmenopausal women with advanced breast cancer: results of a phase III randomized double-blind trial. The Exemestane Study Group. J Clin Oncol 18:1399–1411
Lønning PE, Bajetta E, Murray R et al (2000) Activity of exemestane in metastatic breast cancer after failure of nonsteroidal aromatase inhibitors: a phase II trial. J Clin Oncol 18:2234–2344
Bertelli G, Garrone O, Merlano M et al (2005) Sequential treatment with exemestane and non-steroidal aromatase inhibitors in advanced breast cancer. Oncology 69:471–477. doi:10.1159/000090985
Steele N, Zekri J, Coleman R et al (2006) Exemestane in metastatic breast cancer: effective therapy after third-generation non-steroidal aromatase inhibitor failure. Breast 15:430–436. doi:10.1016/j.breast.2005.08.032
Carlini P, Michelotti A, Ferretti G et al (2007) Clinical evaluation of the use of exemestane as further hormonal therapy after nonsteroidal aromatase inhibitors in postmenopausal metastatic breast cancer patients. Cancer Invest 25:102–105. doi:10.1080/07357900701224789
Chin YS, Beresford MJ, Ravichandran D et al (2007) Exemestane after nonsteroidal aromatase inhibitors for post-menopausal women with advanced breast cancer. Breast 16:436–439. doi:10.1016/j.breast.2007.02.002
Robertson JF, Osborne CK, Howell A et al (2003) Fulvestrant versus anastrozole for the treatment of advanced breast carcinoma in postmenopausal women: a prospective combined analysis of two multicenter trials. Cancer 98:229–238. doi:10.1002/cncr.11468
Chia S, Gradishar W (2008) Fulvestrant: expanding the endocrine treatment options for patients with hormone-receptor-positive advanced breast cancer. Breast 17(Suppl 3):S16–S21. doi:10.1016/j.breast.2007.12.004
Safra T, Greenberg J, Ron IG et al (2008) Fulvestrant in heavily pretreated metastatic breast cancer: is it still effective as a very advanced line of treatment? Isr Med Assoc J 10:339–343
Bartsch R, Mlineritsch B, Gnant M et al (2008) The Austrian fulvestrant registry: results from a prospective observation of fulvestrant in postmenopausal patients with metastatic breast cancer. Breast Cancer Res Treat. doi:10.1007/s10549-008-0132-0
Gligorov J, Azria D, Namer M et al (2007) Novel therapeutic strategies combining antihormonal and biological targeted therapies in breast cancer: focus on clinical trials and perspectives. Crit Rev Oncol Hematol 64:115–128. doi:10.1016/j.critrevonc.2007.06.010
Lane HA, Lebwohl D (2006) Future directions in the treatment of hormone-sensitive advanced breast cancer: the RAD001 (Everolimus)-letrozole clinical program. Semin Oncol 33(2 suppl 7):S18–S25. doi:10.1053/j.seminoncol.2006.03.024
Wakeling AE (2005) Inhibitors of growth factor signalling. Endocr Relat Cancer 12(Suppl 1):S183–S187. doi:10.1677/erc.1.01014
Demonty G, Bernard-Marty C, Puglisi F et al (2007) Progress and new standards of care in the management of HER-2 positive breast cancer. Eur J Cancer 43:497–509. doi:10.1016/j.ejca.2006.10.020
Slamon DJ, Clark GM, Wong SG et al (1987) Human breast cancer: correlation of relapse and survival with amplification of the HER-2/neu oncogene. Science 235:177–182. doi:10.1126/science.3798106
De Placido S, Carlomagno C, De Laurentiis M et al (1998) c-erbB2 expression predicts tamoxifen efficacy in breast cancer patients. Breast Cancer Res Treat 52:55–64. doi:10.1023/A:1006159001039
Ross JS, Fletcher JA (1998) The HER-2/neu oncogene in breast cancer: prognostic factor, predictive factor, and target for therapy. Stem Cells 16:413–428
Ellis MJ, Coop A, Singh B et al (2001) Letrozole is more effective neoadjuvant endocrine therapy than tamoxifen for ErbB-1- and/or ErbB-2-positive, estrogen receptor-positive primary breast cancer: evidence from a phase III randomized trial. J Clin Oncol 19:3808–3816
Kaufmann B, Makdey J, Clemens M et al (2006) Trastuzumab plus anastrozole prolongs progression-free survival in postmenopausal women with HER2-positive, hormone-dependent metastatic breast cancer (MBC). Ann Oncol 17(Suppl 9): Abstract LBA2
Salomon DS, Brandt R, Ciardiello F et al (1995) Epidermal growth factor-related peptides and their receptors in human malignancies. Crit Rev Oncol Hematol 19:183–232. doi:10.1016/1040-8428(94)00144-I
Knowlden JM, Hutcheson IR, Jones HE et al (2003) Elevated levels of epidermal growth factor receptor/c-erbB2 heterodimers mediate an autocrine growth regulatory pathway in tamoxifen-resistant MCF-7 cells. Endocrinology 144:1032–1044. doi:10.1210/en.2002-220620
Nicholson RI, Hutcheson IR, Harper ME et al (2001) Modulation of epidermal growth factor receptor in endocrine-resistant, oestrogen receptor-positive breast cancer. Endocr Relat Cancer 8:175–182. doi:10.1677/erc.0.0080175
Chu I, Blackwell K, Chen S et al (2005) The dual ErbB1/ErbB2 inhibitor, lapatinib (GW572016), cooperates with tamoxifen to inhibit both cell proliferation- and estrogen-dependent gene expression in antiestrogen-resistant breast cancer. Cancer Res 65:18–25
Johnston SR (2005) Combinations of endocrine and biological agents: present status of therapeutic and presurgical investigations. Clin Cancer Res 11:889s–899s
Perez-Tenorio G, Stal O, Southeast Sweden Breast Cancer Group (2002) Activation of AKT/PKB in breast cancer predicts a worse outcome among endocrine treated patients. Br J Cancer 86:540–545. doi:10.1038/sj.bjc.6600126
Clark AS, West K, Streicher S et al (2002) Constitutive and inducible Akt activity promotes resistance to chemotherapy, trastuzumab, or tamoxifen in breast cancer cells. Mol Cancer Ther 1:707–717
Yu K, Toral-Barza L, Discafani C et al (2001) mTOR, a novel target in breast cancer: the effect of CCI-779, an mTOR inhibitor, in preclinical models of breast cancer. Endocr Relat Cancer 8:249–258. doi:10.1677/erc.0.0080249
de Graffenried LA, Friedrichs WE, Russell DH et al (2004) Inhibition of mTOR activity restores tamoxifen response in breast cancer cells with aberrant Akt activity. Clin Cancer Res 10:8059–8067. doi:10.1158/1078-0432.CCR-04-0035
Hynes NE, Boulay A (2006) The mTOR pathway in breast cancer. J Mammary Gland Biol Neoplasia 11:53–61. doi:10.1007/s10911-006-9012-6
Sini P, Wyder L, Schnell C et al (2005) The antitumor and antiangiogenic activity of vascular endothelial growth factor receptor inhibition is potentiated by ErbB1 blockade. Clin Cancer Res 15(11):4521–4532. doi:10.1158/1078-0432.CCR-04-1954
Lane HA, Schell C, Theuer A et al (2002) Antiangiogenic activity of RAD001, an orally active anticancer agent. Proc Am Assoc Cancer Res 43:184 (Abstract 992)
Boulay A, Rudloff J, Ye J et al (2005) Dual inhibition of mTOR and estrogen receptor signaling in vitro induces cell death in models of breast cancer. Clin Cancer Res 11:5319–5328. doi:10.1158/1078-0432.CCR-04-2402
O’Donnell A, Faivre S, Judson I et al (2003) A phase I study of the oral mTOR inhibitor RAD001 as monotherapy to identify the optimal biologically effective dose using toxicity, pharmacokinetic (PK) and pharmacodynamic (PD) endpoints in patients with solid tumours. Proc Am Soc Clin Oncol 22:200 (Abstract 803)
Tabernero J, Rojo F, Burris H et al (2005) A phase I study with tumor molecular pharmacodynamic (MPD) evaluation of dose and schedule of the oral mTOR-inhibitor everolimus (RAD001) in patients (pts) with advanced solid tumors. J Clin Oncol 23:193s. doi:10.1200/JCO.2005.00.398 (Abstract 3007)
Awada A, Cardoso F, Fontaine C et al (2008) The oral mTOR inhibitor RAD001 (everolimus) in combination with letrozole in patients with advanced breast cancer: results of a phase I study with pharmacokinetics. Eur J Cancer 44:84–91. doi:10.1016/j.ejca.2007.10.003
Di Cosimo S, Seoane J, Guzman M et al (2005) Combination of the mammalian target of rapamycin (mTOR) inhibitor everolimus (E) with the insulin like growth factor-1-receptor (IGF-1-R) inhibitor NVP-AEW-541: a mechanistic based anti-tumor strategy. J Clin Oncol 23:219s (Abstract 3112)
Di Cosimo S, Matar P, Rojo F et al (2004) The mTOR pathway inhibitor RAD001 induces activation of AKT which is completely abolished by gefitinib, an anti-EGFR tyrosine kinase inhibitor, and combined sequence specific treatment results in greater antitumor activity. Proc Am Assoc Cancer Res 44:1233
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365:1687–1717. doi:10.1016/S0140-6736(05)66544-0
Fossati R, Confalonieri C, Torri V et al (1998) Cytotoxic and hormonal treatment for metastatic breast cancer: a systematic review of published randomized trials involving 31, 510 women. J Clin Oncol 16:3439–3460
Robert NJ, Vogel CL, Henderson IC et al (2004) The role of the liposomal anthracyclines and other systemic therapies in the management of advanced breast cancer. Semin Oncol 31(Suppl 13):106–146. doi:10.1053/j.seminoncol.2004.09.018
Safra T (2003) Cardiac safety of liposomal anthracyclines. Oncologist 8(Suppl 2):17–24. doi:10.1634/theoncologist.8-suppl_2-17
Myers C (1998) The role of iron in doxorubicin-induced cardiomyopathy. Semin Oncol 25:10
Ng R, Better N, Green MD (2006) Anticancer agents and cardiotoxicity. Semin Oncol 33:2–14. doi:10.1053/j.seminoncol.2005.11.001
Hasinoff BB (1998) Chemistry of dexrazoxane and analogues. Semin Oncol 25(4 suppl 10):3–9
Villani F, Galimberti M, Monti E et al (1990) Effect of ICRF-187 pretreatment against doxorubicin-induced delayed cardiotoxicity in the rat. Toxicol Appl Pharmacol 102:292–299. doi:10.1016/0041-008X(90)90028-S
Speyer JL, Green MD, Zeleniuch-Jacquotte A et al (1992) ICRF-187 permits longer treatment with doxorubicin in women with breast cancer. J Clin Oncol 10:117–127
Speyer JL, Green MD, Kramer E et al (1988) Protective effect of the bispiperazinedione ICRF-187 against doxorubicin-induced cardiac toxicity in women with advanced breast cancer. N Engl J Med 319:745–752
Kolaric K, Bradamante V, Cervek J et al (1995) A phase II trial of cardioprotection with cardioxane (ICRF-187) in patients with advanced breast cancer receiving 5-fluorouracil, doxorubicin and cyclophosphamide. Oncology 52:251–255
Venturini M, Michelotti A, Del Mastro L et al (1996) Multicenter randomized controlled clinical trial to evaluate cardioprotection of dexrazoxane versus no cardioprotection in women receiving epirubicin chemotherapy for advanced breast cancer. J Clin Oncol 14:3112–3120
Sparano JA, Speyer J, Gradishar WJ et al (1999) Phase I trial of escalating doses of paclitaxel plus doxorubicin and dexrazoxane in patients with advanced breast cancer. J Clin Oncol 17:880–886
Swain SM, Whaley FS, Gerber MC et al (1997) Cardioprotection with dexrazoxane for doxorubicin-containing therapy in advanced breast cancer. J Clin Oncol 15:1318–1332
Swain SM, Whaley FS, Gerber MC et al (1997) Delayed administration of dexrazoxane provides cardioprotection for patients with advanced breast cancer treated with doxorubicin-containing therapy. J Clin Oncol 15:1333–1340
Seymour L, Bramwell V, Moran LA (1999) Use of dexrazoxane as a cardioprotectant in patients receiving doxorubicin or epirubicin chemotherapy for the treatment of cancer. The Provincial Systemic Treatment Disease Site Group. Cancer Prev Control 3:145–159
van Dalen EC, Caron HN, Dickinson HO et al (2005) Cardioprotective interventions for cancer patients receiving anthracyclines. Cochrane Database Syst Rev 1:CD003917
Ghersi D, Wilcken N, Simes J et al (2005) Taxane containing regimens for metastatic breast cancer. Cochrane Database Syst Rev 2:CD003366
Ershler WB (2006) Capecitabine monotherapy: safe and effective treatment for metastatic breast cancer. Oncologist 11:325–335. doi:10.1634/theoncologist.11-4-325
Mano M (2006) Vinorelbine in the management of breast cancer: new perspectives, revived role in the era of targeted therapy. Cancer Treat Rev 32:106–118. doi:10.1016/j.ctrv.2005.12.008
Smith IE (2006) Overview of gemcitabine activity in advanced breast cancer. Semin Oncol 33(3 suppl 9):S19–S23. doi:10.1053/j.seminoncol.2006.03.020
Miller KD, Chap LI, Holmes FA et al (2005) Randomized phase III trial of capecitabine compared with bevacizumab plus capecitabine in patients with previously treated metastatic breast cancer. J Clin Oncol 23:792–799. doi:10.1200/JCO.2005.05.098
Miller K, Wang M, Gralow J et al (2007) Paclitaxel plus bevacizumab versus paclitaxel alone for metastatic breast cancer. N Engl J Med 357:2666–2676. doi:10.1056/NEJMoa072113
Sledge G, Miller K, Moisa C et al (2007) Safety and efficacy of capecitabine (C) plus bevacizumab (B) as first-line in metastatic breast cancer. J Clin Oncol 25(18S) (Abstract 1013)
Miles D, Chan A, Romieu G et al (2008) Randomized, double-blind, placebo-controlled, phase III study of bevacizumab with docetaxel or docetaxel with placebo as first-line therapy for patients with locally recurrent or metastatic breast cancer (mBC): AVADO. J Clin Oncol 26 (Abstract LBA1011)
Body JJ (2006) Breast cancer: bisphosphonate therapy for metastatic bone disease. Clin Cancer Res 12:6258s–6263s. doi:10.1158/1078-0432.CCR-06-0840
Santini D, Fratto ME, Vincenzi B et al (2006) Zoledronic acid in the management of metastatic bone disease. Expert Opin Biol Ther 6:1333–1348. doi:10.1517/14712598.6.12.1333
Gnant M, Mlineritsch B, Luschin-Ebengreuth G et al (2008) Adjuvant endocrine therapy plus zoledronic acid in premenopausal women with early-stage breast cancer: 5-year follow-up of the ABCSG-12 bone-mineral density substudy. Lancet Oncol 9:840–849. doi:10.1016/S1470-2045(08)70204-3
Conte PF, Rosen LS, Gordon D et al (2004) Zoledronic acid is superior to pamidronate in patients with breast cancer and multiple myeloma: analysis of patients at high risk for skeletal complications. Ann Oncol 15(Suppl 3):iii124 (Abstract 463PD)
Hei YJ, Saad F, Coleman RE, Chen YM (2005) Fractures negatively affect survival in patients with bone metastases from breast cancer. Breast Cancer Res Treat 88 (Abstract 6036)
Hortobagyi GN, Theriault RL, Lipton A et al (1998) Long-term prevention of skeletal complications of metastatic breast cancer with pamidronate. Protocol 19 Aredia Breast Cancer Study Group. J Clin Oncol 16:2038–2044
Theriault RL, Lipton A, Hortobagyi GN et al (1999) Pamidronate reduces skeletal morbidity in women with advanced breast cancer and lytic bone lesions: a randomized, placebo-controlled trial. Protocol 18 Aredia Breast Cancer Study Group. J Clin Oncol 17:846–854
Kohno N, Aogi K, Minami H et al (2005) Zoledronic acid significantly reduces skeletal complications compared with placebo in Japanese women with bone metastases from breast cancer: a randomized, placebo-controlled trial. J Clin Oncol 23:3314–3321. doi:10.1200/JCO.2005.05.116
Sherer JT, Adamus AT (2007) Outcomes of patients with prostate cancer receiving zoledronic acid or pamidronate for prevention of skeletal-related events. Pharmacotherapy 27:207–217. doi:10.1592/phco.27.2.207
Gordon DH (2005) Efficacy and safety of intravenous bisphosphonates for patients with breast cancer metastatic to bone: a review of randomized, double-blind, phase III trials. Clin Breast Cancer 6:125–131
Wardley A, Davidson N, Barrett-Lee P et al (2005) Zoledronic acid significantly improves pain scores and quality of life in breast cancer patients with bone metastases: a randomised, crossover study of community vs hospital bisphosphonate administration. Br J Cancer 92:1869–1876. doi:10.1038/sj.bjc.6602551
Wong R, Wiffen PJ (2002) Bisphosphonates for the relief of pain secondary to bone metastases. Cochrane Database Syst Rev 2:CD002068
Hoff AO, Toth BB, Altundag K et al (2006) Osteonecrosis of the jaw in patients receiving intravenous bisphosphonate therapy. J Clin Oncol 24 (Abstract 8528)
Diel IJ, Fogelman I, Al-Nawas B et al (2007) Pathophysiology, risk factors and management of bisphosphonate-associated osteonecrosis of the jaw: is there a diverse relationship of amino- and non-aminobisphosphonates? Crit Rev Oncol Hematol 64:198–207. doi:10.1016/j.critrevonc.2007.07.005
Coleman RE, Major P, Lipton A et al (2005) Predictive value of bone resorption and formation markers in cancer patients with bone metastases receiving the bisphosphonate zoledronic acid. J Clin Oncol 23:4925–4935. doi:10.1200/JCO.2005.06.091
Coleman R, Brown J, Terpos E et al (2008) Bone markers and their prognostic value in metastatic bone disease: clinical evidence and future directions. Cancer Treat Rev 34:629–639. doi:10.1016/j.ctrv.2008.05.001
Financial disclosure/conflict of interest statement
The authors of this article has no commercial associations (e.g., consultancies, stock ownership, equity interests, patentlicensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All funding sources supporting the work and all institutional or corporate affiliations of the author are acknowledged.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gligorov, J., Lotz, JP. Optimal treatment strategies in postmenopausal women with hormone-receptor-positive and HER2-negative metastatic breast cancer. Breast Cancer Res Treat 112 (Suppl 1), 53–66 (2008). https://doi.org/10.1007/s10549-008-0232-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10549-008-0232-x