The goals of treatment of metastatic breast cancer are to prolong survival and improve quality of life by reducing cancer-related symptoms. In order to achieve these goals, an individualized approach is needed since no one strategy can be applied for all women. Cytotoxic chemotherapy may be used to achieve these goals in the following situations:
- Hormone receptor-negative breast cancer – Unlike patients with hormone receptor-positive breast cancer, these patients are not candidates for endocrine therapy.
- Patients with symptomatic hormone receptor-positive breast cancer, in whom endocrine therapy is unlikely to result in a prompt clinical response . These include patients who present with:
- Rapid disease progression following more than one endocrine therapy (ie, endocrine-resistant disease)
- A large tumor burden involving visceral organs
Patients with Human Epidermal Growth Factor Receptor 2 (HER2)-positive disease should have a HER2-directed agent included as part of their treatment. A discussion on the approach to treatment of HER2-positive breast cancer is covered separately.
In general, we prefer not to administer chemotherapy with endocrine therapy for women with hormone receptor-positive disease in order to minimize side effects, including an increased risk of thromboembolic events . In addition, a 1998 meta-analysis showed that combining these treatments was not more effective than the use of chemotherapy alone . The administration of endocrine therapy for patients with hormone receptor-positive metastatic breast cancer is covered separately.