Skip to main content

Advertisement

SpringerLink
Log in

Chemotherapie des metastasierenden Mammakarzinoms

Chemotherapy of metastatic breast cancer

  • Themenschwerpunkt: Therapiekonzepte Beim Operablen Mammakarzinom
  • Published:
Acta Chirurgica Austriaca Aims and scope Submit manuscript

Zusammenfassung

Durch konventionelle Chemotherapieregime können bei Patientinnen mit metastasierendem Mammakarzinom in 40 bis 70% der Fälle objektive Tumorrückbildungen erreicht werden, allerdings bei nur 10 bis 20% der behandelten Patientinnen in Form einer kompletten Remission. Die mediane Remissionsdauer beträgt gewöhnlich 10 bis 12, das mediane Überleben 16 bis 24 Monate. Für keine bestimmte Zytostatikakombination ergab sich bisher eine signifikante Überlegenheit. Nachdem bereits vor einigen Jahren ein therapeutisches Plateau erreicht wurde, zielen neuere Intentionen darauf ab, durch Entwicklung neuerer Substanzen mit verbessertem therapeutischem Index, durch risikoadaptierte Therapie und Begrenzung der Therapiedauer die Lebensqualität der behandelten Patientinnen vermehrt zu berücksichtigen.

Summary

Conventional chemotherapy regimens induce tumor regression in 40 to 70% of patients with metastatic breast cancer. Complete remissions occur in only 10 to 20% of treated patients. The median response duration is usually 10 bis 12 months, the median survival 16 to 24 months. No single combination has proven reproducibly superior. The plateau in treatment results using 3 to 5 drugs in combination at standard doses has led to newer strategies. These include the development of agents with less toxicity, more appropriate selection of patients, based on prognostic factors and reducing duration of treatment in responding patients in regard to improve quality of life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Ahmann D, O'Fallon J, O'Connel MT, et al: Evaluation of fixed alternating treatment in patients with advanced breast cancer. Cancer Clin Trials 1978;1:219–226.

    PubMed  CAS  Google Scholar 

  2. Aisner J, Weinberg V, Perloff M, et al: Chemotherapy versus chemoimmunotherapy (CAF v CAFVP v CMF MER) for metastatic carcinoma of the breast. A CALGB study. J Clin Oncol 1987;5:1523–1533.

    PubMed  CAS  Google Scholar 

  3. Aisner J, Korzun, A, Perloff M, et al: A Randomized Comparison of CAF, VATH and VATH Alternating with CMFVP for Advanced Breast Cancer. Proc ASCO 1988;7:27.

    Google Scholar 

  4. Allegra JC, Woodcock T, Woolf S, et al: A randomized trial comparing mitoxantrone with doxorubicin in patients with stage IV breast cancer. Invest N Drugs 1985;3:153–161.

    CAS  Google Scholar 

  5. Antman KS, Griffin JD, Elias A, et al: Effect of recombinant human granulocyte-macrophage colony-stimulating factor on chemotherapy-induced myelosuppression. N Engl J Med 1988;319:593–598.

    Article  PubMed  CAS  Google Scholar 

  6. Bastholt L, Dalmark M, et al: Phase II Study of Idarubicin Given Orally in the Treatment of Anthracycline-Native Advanced Breast Cancer Patients. Cancer Treat Rep 1987;71:451–454.

    PubMed  CAS  Google Scholar 

  7. Bennet JM, Muss HB, Doroshow JH, et al: A Randomized Trial Comparing Mitoxantrone, Cyclophosphamide, and Fluorouracil With Doxorubicin, Cyclophosphamide, and Fluorouracil in the Therapy of Metastatic Breast Carcinoma. J Clin Oncol 1988;6:1611–1620 (1988).

    Google Scholar 

  8. Bonadonna G, Veronesi U, Brambilla L, et al: Primary Chemotherapy to Avoid Mastectomy in Tumors with Diameters of Three Centimeters or more. J Natl Cancer Inst 1990;82:1532–1545.

    Article  Google Scholar 

  9. Brambilla C, de Lena M, Rossi A, et al: Response and survival in advanced breast cancer after two non-cross-resistant combinations. Br Med J 1976;1:801–804.

    PubMed  CAS  Google Scholar 

  10. Broder LE, Tormey CD, et al: Combination chemotherapy of carcinoma of the breast. Cancer Treat Res 1974;1:183–203.

    Article  Google Scholar 

  11. Bull JM, Tormey DC, Shou-Hua L, et al: A randomized comparative trial of adriamycin versus methotrexate in combination drug therapy. Cancer 1978;41:1649–1657.

    Article  PubMed  CAS  Google Scholar 

  12. Canellos GP, Pocock SJ, Taylor SG, et al: Combination chemotherapy for metastatic breast carcinoma. Prospective comparison of multiple drug therapy with L-phenylalanine mustard. Cancer 1976;38:1882–1886.

    Article  PubMed  CAS  Google Scholar 

  13. Canobbio L, Postorino G, Brema F, et al: Efficacy of Navelbine® in advanced breast cancer. Sem Oncol 1989; (Suppl 4):33–36.

    Google Scholar 

  14. Carbone PP, Tormey DC: Combination chemotherapy for advanced disease, in Mc Guire WL (ed): Breast Cancer: Advances in Research and Treatment. New York, Plenum, 1977, pp 155–215.

    Google Scholar 

  15. Carbone PP, Bauer M, Band P, Tormey D: Chemotherapy of disseminated breast cancer: Current status and prospects. Cancer 1977;39:2916–2922.

    Article  PubMed  CAS  Google Scholar 

  16. Carter SK: Integration of chemotherapy into combined modality treatment of solid tumors. Cancer Treat Rev. 1976;3:141–174.

    Article  PubMed  CAS  Google Scholar 

  17. Casazza AM, Giuliani FC: Preclinical properties of epirubicin, in Bonadonna G (ed): Advances in Anthracycline Chemotherapy: Epirubicin. Milano, Masson Italia Editori, 1984, pp 31–40.

    Google Scholar 

  18. Cavalli F, Beer M, Martz G, et al: Gleichzeitige oder sequentielle Hormon-Chemotherapien sowie Vergleich verschiedener Polychemotherapien in der Behandlung des metastasierenden Mammakarzinoms. Schweiz Med Wschr 1982;112:774–783.

    PubMed  CAS  Google Scholar 

  19. Coates A, Gebski V, Bishop JF, et al: Improving the quality of life during chemotherapy for advanced breast cancer. N Engl J Med 1987;317:1490–1495.

    Article  PubMed  CAS  Google Scholar 

  20. Cocconi G, Bisagui G, Bocchi M, et al: Cisplatin and Etoposide as First-Line Chemotherapy for Metastatic Breast Carcinoma. A Prospective Randomized Trial of the Italian Oncology Group for Clinical Research. J Clin Oncol 1991;9:664–669.

    PubMed  CAS  Google Scholar 

  21. Cooper R: Combination Chemotherapy in hormone resistant breast Cancer. Proc Ass Cancer Res 1969;10:15.

    Google Scholar 

  22. Creech RH, Catalano RB, Mastrangelo MJ, et al: An effective low-dose intermittend cyclophosphamide, methotrexate and 5-fluorouracil treatment regimen for metastatic breast cancer patients. Cancer 1980;46:433–437.

    Article  PubMed  CAS  Google Scholar 

  23. Creech RH, Catalano RB, Shab MK: An effective low-dose Adriamycin regimen as secondary chemotherapy for metastatic breast cancer patients. Cancer 1980;46:433–437.

    Article  PubMed  CAS  Google Scholar 

  24. Dieras V, De Cremoux P, Exctra JM, et al: A two stage sequential phase II study of vinorelbine in patients with previously treated breast cancer. Breast Cancer Res Treat 1989;14:146.

    Google Scholar 

  25. Dunphy FR, Spitzer G, Buzdar AU, et al: Treatment of Estrogen Receptor-Negative or Hormonally Refractory Breast Cancer With Double High-Dose Chemotherapy Intensification and Bone Marrow Support. J Clin Oncol 1990;8:1207–1216.

    PubMed  CAS  Google Scholar 

  26. Ejlertsen B, Pfeiffer P, Pedersen D, et al: Diminished efficacy by reducing duration of CEF from 18 to 6 months in the treatment of metastatic breast cancer. Proc Am Soc Clin Oncol 1990;9:23.

    Google Scholar 

  27. Engelsman E, Rubens R, Klijn J, et al: Comparison of “Classical CMF” with a three weekly intravenous schedule in postmenopausal patients with advanced breast cancer: An EORTC Study (Trial 10808). Proc EORTC 1987;1.7 (abstract).

    Google Scholar 

  28. French Epirubicin Study Group: A Prospective Randomized Phase III Trial Comparing Combination Chemotherapy With Cyclophosphamide, Fluorouracil, and Either Doxorubicin or Epirubicin. J Clin Oncol 1988;6:679–688.

    Google Scholar 

  29. Ganzina F: 4′-Epi-doxorubicin, a new analogic of doxorubicin: A preliminary overview of preclinical and clinical data. Cancer Treat Rev 1983;10:1–22.

    Article  PubMed  CAS  Google Scholar 

  30. George SL, Hoogstraten B: Prognostic factors in the initial response to therapy by patients with advanced breast cancer. J Natl Cancer Inst 1978;60:731–736.

    PubMed  CAS  Google Scholar 

  31. Gianni AM, Bregni M, Siena S, et al: Recombinant Human Granulocyte-Macrophage Colony-Stimulation Factor Reduces Hematologic Toxicity and Widens Clinical Applicability of High-Dose Cyclophosphamide Treatment in Breast Cancer and Non-Hodgkin's Lymphoma. J Clin Oncol 1990;8:768–778.

    PubMed  CAS  Google Scholar 

  32. Goldie JH, Coldman AJ, Gudauskas GA: Rationale for the use of alternating non-cross-resistant chemotherapy. Cancer Treat Rep 1982;66:439–449.

    PubMed  CAS  Google Scholar 

  33. Habeshaw T, Paul J, Jones R, et al: Epirubicin at Two Dose Levels With Prednisolone as Treatment for Advanced Breast Cancer: The Results of a Randomized Trial. J Clin Oncol 1991;9:295–304.

    PubMed  CAS  Google Scholar 

  34. Harris AL, Cantwell BM, Carmichael J, et al: Comparison of short-term and continuous chemotherapy (mitoxantrone) for advanced breast cancer. Lancet 1990;335:186–190.

    Article  PubMed  CAS  Google Scholar 

  35. Hausmaninger H: Palliativtherapie des fortgeschrittenen Mammakarzinoms. Wien klin Wschr 1986;17:591–592.

    Google Scholar 

  36. Hausmaninger H, Lehnert M, Steger G, et al: Vindesine-Epirubicin versus Vindesine-Mitoxiantrone in Metastatic Breast Cancer. Onkologie 1989;12:225–229.

    PubMed  CAS  Google Scholar 

  37. Henderson IC: Chemotherapy for advanced disease, in Bonadonna G (ed): Breast Cancer: Diagnosis and Management. New York, Wiley, 1984, pp 247–280.

    Google Scholar 

  38. Henderson IC, Woolff S, Allegra JC: Randomized clinical trial comparing mitoxantrone with doxorubicin in previously treated patients with metastatic breast cancer. Proc ASCO 1985;4:62.

    Google Scholar 

  39. Henderson I, Hayes F: Dose-response in the treatment of breast cancer: A critical review. J Clin Oncol 1988;6:1501–1515.

    PubMed  CAS  Google Scholar 

  40. Herrmann R, Manegold C, Schroeder M, et al: Sequential methotrexate and 5-FU in breast cancer resistant to the conventional application of these drugs. Cancer Treat Rep 1984;68:1279–1281.

    PubMed  CAS  Google Scholar 

  41. Hillner BE, Smith IJ, Desch CE: Estimating the cost-effectiveness of autologous bone marrow transplantation for metastatic breast cancer. Proc Am Soc Clin Oncol 1991;10:46.

    Google Scholar 

  42. Hortobagyi GN, Bodey GP, Buzdar AU, et al: Evaluation of High-Dose versus Standard FAC Chemo-therapy for Advanced Breast Cancer in Protected Environment Units: A Prospective Randomized Study. J Clin Oncol 1987;5:354–364.

    PubMed  CAS  Google Scholar 

  43. Hryniuk W, Bush H: The importance of dose intensity in chemotherapy of metastatic breast cancer. J Clin Oncol 1984;2:1281–1288.

    PubMed  CAS  Google Scholar 

  44. Humblet Y, Doyen C, Michael C, et al: A Randomized Phase III Study in Advanced Breast Cancer. Cyclophosphamide (C) and Vindesine (V) in Association with either Adriamycin (A) or Epirubicin (E): An Interim Analysis. Proc ASCO 1988;7:105.

    Google Scholar 

  45. Italian Multicentre Breast Study With Epirubicin: Phase III Randomized Study of Fluorouracil, Epirubicin, and Cyclophosphamide in Fluorouracil, Doxorubicin, and Cyclophosphamide in Advanced Breast Cancer: An Italian Multicentre Trial. J Clin Oncol 1988;6:976–982.

    Google Scholar 

  46. Jain K, Caspar ES, Geller NL, et al: A prospective randomized comparison of epirubicin and doxorubicin in patients with advanced breast cancer. J Clin Oncol 1985;3:818–826.

    PubMed  CAS  Google Scholar 

  47. Jones RB, Shprall EJ, Shogan J, et al: The Duke AFM Program. Intensive Induction Chemotherapy for Metastatic Breast Cancer. Cancer 1990;66:431–436.

    Article  PubMed  CAS  Google Scholar 

  48. Kiang DT, Frenning DH, Goldman A, et al: Estrogen receptors and responses to chemotherapy and hormonal therapy in advanced breast cancer. N Engl J Med 1978;299:1330–1334.

    Article  PubMed  CAS  Google Scholar 

  49. Kiang DT, Kennedy BJ, Korzum A, et al: (CALGB): Alternating Chemotherapy for Poor Prognostic Breast Cancer. Proc ASCO 1988;7:67.

    Google Scholar 

  50. Krook JE, Loprinzi CL, Schaid DJ, et al: Evaluation of the Continuous Infusion of Etoposide Plus Cisplatin in Metastatic Breast Cancer. Cancer 1990;65:418–421.

    Article  PubMed  CAS  Google Scholar 

  51. Lenzhofer R, Rainer H, Schuster R, et al: Mitoxantrone zur Erstbehandlung des metastasierten Mammakarzinoms. Wien klin Wschr 1984;96:319–326.

    PubMed  CAS  Google Scholar 

  52. Lichtin A, Weich J, Anresen S, et al: Treatment of metastatic breast cancer with high-dose chemotherapy followed by autologous bone marrow transplantation. Proc Am Soc Clin Oncol 1991;10:54.

    Google Scholar 

  53. Lippmann ME, Allegra JC, Thompson EH: The relation between estrogen receptors and response rate to cytotoxic chemotherapy in metastatic breast cancer. N Engl J Med 1978;298:1223–1229.

    Article  Google Scholar 

  54. Lloyd RE, Jones SE, Salmon SE: Southwest Oncology Group Members: Phase II trial of Adriamycin and Cyclophosphamide: A Southwest Oncology Group pilot study. Proc AACR 1975;16:265.

    Google Scholar 

  55. Lloyd RE, Jones SE, Salmon SE: Comparative trial of low-dose adriamycin plus cyclophosphamid with or without additive hormonal therapy in advanced breast cancer. Cancer 1979;43:60–65.

    Article  PubMed  CAS  Google Scholar 

  56. Löber J, Mouridsen HT, Christensen IE, et al: A phase III trial comparing prednimustine (Leo 1031) to chlorambucil plus prednisolone in advanced breast cancer. Lancet 1983;52:1570–1576.

    Google Scholar 

  57. Mouridsen HT, Kristensen D, Nielsen H, et al: Phase II Trial of Prednimustine, Leo 1031, (NSC-134087) in Advanced Breast cancer. Cancer 1980;46:253–255.

    Article  PubMed  CAS  Google Scholar 

  58. Mouridsen HT, Cornbleet M, Stuart-Harris R, et al: Mitoxantrone as first-line chemotherapy in advanced breast cancer. Results of a collaborative European Study. Invest N Drugs 1985;3:139–148.

    CAS  Google Scholar 

  59. Muss H, Case D, Read S, et al: Induction chemotherapy followed by maintenance or observation in women with metastatic breast cancer: A randomized trial of the Piedmont Oncology Association. Proc Am Soc Clin Oncol 1990;9:22.

    Google Scholar 

  60. Nagel GA, Wander HE, Bartsch HH, et al: Zur Frage der Erhaltungstherapie bei Patientinnen mit metastasierendem Mammakarzinom in Remission, in Nagel CA (Hrsg): Mammakarzinome. Berlin-Heidelberg-New York-Tokyo, Springer, 1986, pp 92–99.

    Google Scholar 

  61. Nooy MA, Beex LVAM, Rotmensz N, Sylvester R: “Short” versus longterm chemotherapy with CMF in postmenopausal patients with advanced breast cancer, a phase III trial (Trial 10852). Proc EORTC 1987;1 08 (abstract).

    Google Scholar 

  62. O'Shanghuessy J, Denicoff AM, Stanforth D, et al: Combination Chemotherapy with Fluorouracil, Leucovorin, Adriamycin and Cytoxan with Granulocyte-Macrophage Colony Stimulation Factor for Patients with Stage II B, III A, and II B locally Advanced and Metastatic Breast Cancer. Proc Am Soc Clin Oncol 1991;10:72.

    Google Scholar 

  63. Peters WP, Shpall EJ, Jones RB, et al: High-Dose Combination Alkylating Agents With Bone Marrow Support as Initial Treatment for Metastatic Breast Cancer. J Clin Oncol 1988;6:1368–1376.

    PubMed  CAS  Google Scholar 

  64. Petru E, Schmähl D: Bedeutung der Zusammensetzung verschiedener Kombinationsschemata bei der Chemotherapie des metastasierenden Mammakarzinoms. Dtsch med Wschr 1987;11:270–275.

    Article  Google Scholar 

  65. Petru E: Zytostatische Therapie des metastasierenden Marrmakarzinoms. Therapiew Österr 1988;1:27–36.

    Google Scholar 

  66. Plotkin D, Ray M, Chien P: Sequential Methotrexate and 5-Fluorouracil in Advanced Breast and Colorectal Cancer: A Non-Randomized Pilot Study. Proc ASCO 1988;7:95.

    Google Scholar 

  67. Possinger K, Sauer HJ, Wilmans W: Chemotherapie metastasierter Mammakarzinome. Dtsch Med Wschr 1988;113:224–231.

    Article  PubMed  CAS  Google Scholar 

  68. Possinger K, Sauer HJ, Wilmanns W: Chemotherapie metastasierter Mammakarziomes. Dtsch Med Wschr 1980;113:224–231.

    Article  Google Scholar 

  69. Possinger K, Wagner H, Worst P, et al: Oral Administration of Idarubicin as First Line Cytostatic Therapy in Patients with Metastasized Breast Cancer and Favourable Prognosis. Onkologie 1991;14:31–34.

    Article  PubMed  CAS  Google Scholar 

  70. Powles TJ, Coombes RC, Smith IE, et al: Failure of chemotherapy to prolong survival in a group of patients with metastatic breast cancer. Lancet 1980;1:580–582.

    Article  PubMed  CAS  Google Scholar 

  71. Rosenzweig M, Staquet MJ, von Hoft DD: Prognostic factors for the response to chemotherapy in advanced breast cancer. Cancer Clin Trials 1979;2:165–170.

    Google Scholar 

  72. Schmid H, Raeth U, Manegold C, et al: Prednimustine and mitoxantrone (NOSTE) in the treatment of advanced breast cancer. Proceedings of a satellite symposium, Hamburg, 1987, pp 43–52.

  73. Senn HJ: Indikationen, Erfolgsaussichten und praktische Durchführung der internistischen Krebstherapie, in Brunner KW, Nagel GA (Hrsg): Internistische Krebstherapie. 3. Auflage. Berlin-Heidelberg-New York-Tokyo, Springer, 1985.

    Google Scholar 

  74. Slater A, Yoset H, Keen CW, et al: Sterecytor cyclophosphamide in combination with methotrexate and 5-FU in advanced breast cancer. Proc ASCO 1988:233.

  75. Sledge GW, Loehrer PJ, Roth BJ, et al: Cisplatin as First-Line Therapy for Metastatic Breast Cancer. J Clin Oncol 1988;6:1811–1814.

    PubMed  Google Scholar 

  76. Sledge G, Roth B, Munski N, et al: High-Dose Epirubicin as First-line Therapy for Advanced Breast Cancer. Proc Am Soc Clin Oncol 1991;10:68.

    Google Scholar 

  77. Smalley RV, Murphy S, Huguley CM, et al: Combination versus sequential five-drug chemotherapy in metastatic breast cancer. Cancer Res 1976;36:3911–3916.

    PubMed  CAS  Google Scholar 

  78. Smalley RV, Bartolucci A: Variations in responsiveness and survival of clinical subsets of patients with metastatic breast cancer to two chemotherapy combinations, in Mouridsen HT, Palshof T (eds). Breast Cancer—Experimental and Clinical Aspects. Oxford-New York, Pergamon Press, 1980, pp 141–146.

    Google Scholar 

  79. Smalley RV, Lefante J, Bartolucci A: CAF v CMFVP in patients with advanced breast cancer. Proc ASCO 1981;22:435.

    Google Scholar 

  80. Smith IE, Coombes RC, Evans BD, et al: Vindesine as a single agent and in combination with adriamycin in the treatment of metastatic breast carcinoma, Mouridsen HT, Palshof T (eds). Breast Cancer—Experimental and Clinical Aspects. Oxford-New York, Pergamon Press, 1980, pp 271–273.

    Google Scholar 

  81. Swenerton KD, Legha SS, Smith T, et al: Prognostic factors in metastatic breast cancer treated with combination chemotherapy. Cancer Res 1979;39:1552–1562.

    PubMed  CAS  Google Scholar 

  82. Tannock IF, Boyd NF, Pertrault DJ, et al: Randomized trial of two doses of CMF chemotherapy for metastatic breast cancer. Proc ASCO 1987:193.

  83. Tormey DC, Weinberg VE, Leone LA, et al: A comparison of intermittend v continuous and of Adriamycin v methotrexate 5-drug chemotherapy for advanced breast cancer. A CALGB study. Am J Clin Oncol 1984;7:231–239.

    Article  PubMed  CAS  Google Scholar 

  84. Vogel CL, Smalley RV, Raney M, et al: Randomized trial of cyclophosphamide, doxorubicin and 5-fluorouracil alone or alternating with a “cycle active” non-cross-resistant combination in women with visceral metastatic breast cancer: A south-Eastern Cancer Study Group Project. J Clin Oncol 1984;2:643–651.

    PubMed  CAS  Google Scholar 

  85. Yap HY, Blumenschein GR, Hortobagyi GN, et al: A randomized comparative study of vinblastine (vlb), vindesine (vds) and vincristine (vcr) in patients (pts) with refractory metastatic breast cancer. Proc ASCO 1981;22:441.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Onkologischen Ambulanz der Landeskrankenanstalten Salzburg, Müllner-Hauptstraße 48, A-5020, Salzburg

    H. Hausmaninger

Authors
  1. H. Hausmaninger
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hausmaninger, H. Chemotherapie des metastasierenden Mammakarzinoms. Acta Chir Austriaca 23, 70–75 (1991). https://doi.org/10.1007/BF02658930

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02658930

Schlüsselwörter

Key-words

Search

Navigation