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Postmenopausal Metastatic Breast Cancer

A Review of First-Line Treatment Options

  • Review Article
  • Published:
American Journal of Cancer

Abstract

Endocrine therapy and chemotherapy play important roles in the management of postmenopausal women with metastatic breast cancer. This paper specifically reviews the indications and options for first-line treatment of metastatic breast cancer and recent advances are highlighted, with particular attention to randomized, controlled, phase III clinical trials.

Until recently, tamoxifen was standard first-line endocrine treatment for patients with metastatic breast cancer. Now, potent third generation aromatase inhibitors, such as letrozole and anastrozole, have shown superiority to tamoxifen as first-line endocrine treatment and provide an alternative for postmenopausal women.

The most active chemotherapy agents for patients with advanced breast cancer have, until recently, been the anthracyclines, doxorubicin and epirubicin. However, their increasing use in the adjuvant setting has resulted in a need for novel active non-cross-resistant cytotoxic drugs for metastatic breast cancer. Real progress has been made with the introduction of the taxanes, paclitaxel and docetaxel. Other developments include the use of single agent cytotoxics such as vinorelbine, the oral fluoropyrimidine capecitabine and gemcitabine, all of which have some activity following either taxanes or anthracyclines, along with a low toxicity profile. Bisphosphonates are bone-specific palliative treatments that have been instituted on the basis of their impact on symptoms and skeletal related morbidity.

Finally, the era of biological therapy in the clinic for patients with breast cancer has been heralded with the development and introduction of trastuzumab, a humanized monoclonal antibody which targets the cell surface growth factor receptor HER2/neu. Importantly, each of these new treatment options has provided an incremental improvement in efficacy over previous standard first-line therapies.

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The author has received funding from the Jansen Research Foundation, AstraZenica and Novatis.

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  1. Breast Unit, Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK

    Laura Assersohn &  Stephen R.D. Johnston

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  1. Laura Assersohn
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Assersohn, L., Johnston, S.R. Postmenopausal Metastatic Breast Cancer. Am J Cancer 2, 95–109 (2003). https://doi.org/10.2165/00024669-200302020-00003

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