Chemotherapy for Advanced Breast Cancer – How Long Should it Continue?

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Chemotherapy is given to most women with advanced breast cancer, but its optimal duration is poorly defined. A systematic review identified four randomised trials comparing more with fewer cycles of the same chemotherapy in women with advanced breast cancer. Meta-analysis of these four trials including 766 women showed a modest, survival advantage for women randomized to more cycles of chemotherapy (median survival 23% longer with more cycles, p = 0.01). Small increments in survival duration are valued highly by women with breast cancer. Quality of life was also better with more cycles of chemotherapy than fewer in the one trial that measured it. The combined evidence from these trials supports a policy of continuing chemotherapy in the absence of disease progression or significant side effects. Decisions about continuing or stopping treatment should be made by the patient and doctor guided by monitoring and consideration of symptoms, signs, side effects, quality of life and preferences.