Metastatic breast cancer

Therapeutic options according to molecular subtypes and prior adjuvant therapy

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70 Citations (Scopus)

Abstract

In spite of advances in treatment strategies, about 25%-40% of patients with breast cancer still eventually develop metastatic disease that is largely incurable. Treatment goals vary from symptom control to lengthening survival, mainly on the basis of patient age and performance status, tumor biology, site and extent of disease, and prior therapies. In particular, breast cancer molecular characterization allows for the identification of breast cancer subtypes with distinct biological features, a distinct clinical course, and distinct treatment sensitivity. Endocrine manipulation is the cornerstone of therapy in hormone receptor-positive tumors; anti-human epidermal growth factor receptor (HER)-2 agents are essential in the management of HER-2+ tumors; and chemotherapy is the only available option so far for the triple-negative subtype. In each of these subtypes, the more efficacious agents have been progressively incorporated into adjuvant treatment. As a consequence, the choice of the optimal therapeutic strategy for patients with metastatic disease is largely influenced by prior exposure to adjuvant therapies. This review contextualizes the data from clinical trials into different clinical scenarios of metastatic disease, taking into account the molecular subtype and prior adjuvant treatments.

Original languageEnglish
Pages (from-to)645-656
Number of pages12
JournalThe oncologist
Volume14
Issue number7
DOIs
Publication statusPublished - Jul 2009

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Breast Neoplasms
Therapeutics
Neoplasms
Clinical Trials
Hormones
Drug Therapy
Survival

Keywords

  • Adjuvant therapy
  • Metastatic breast cancer
  • Molecular subtypes

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

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abstract = "In spite of advances in treatment strategies, about 25{\%}-40{\%} of patients with breast cancer still eventually develop metastatic disease that is largely incurable. Treatment goals vary from symptom control to lengthening survival, mainly on the basis of patient age and performance status, tumor biology, site and extent of disease, and prior therapies. In particular, breast cancer molecular characterization allows for the identification of breast cancer subtypes with distinct biological features, a distinct clinical course, and distinct treatment sensitivity. Endocrine manipulation is the cornerstone of therapy in hormone receptor-positive tumors; anti-human epidermal growth factor receptor (HER)-2 agents are essential in the management of HER-2+ tumors; and chemotherapy is the only available option so far for the triple-negative subtype. In each of these subtypes, the more efficacious agents have been progressively incorporated into adjuvant treatment. As a consequence, the choice of the optimal therapeutic strategy for patients with metastatic disease is largely influenced by prior exposure to adjuvant therapies. This review contextualizes the data from clinical trials into different clinical scenarios of metastatic disease, taking into account the molecular subtype and prior adjuvant treatments.",
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