Advanced breast cancer includes locally advanced and metastatic breast cancer.1The goals of treatment in advanced breast cancer are to maximise length of life (overall survival) and quality of life.
There are a number of important components of clinical care for women with advanced breast cancer. These include using anti-cancer treatments to control disease-related symptoms and slow progression of disease, minimising treatment-related toxicity, and reducing the intrusion of the disease and treatment on a woman's life. Improvements in cancer treatment mean that some women will live for many years after a diagnosis of advanced breast cancer.
The standard systemic treatments for women with advanced breast cancer include chemotherapy, targeted therapy and endocrine therapy.
Chemotherapy drugs used to treat advanced breast cancer include:
- alkylating agents, e.g. cyclophosphamide
- anthracyclines, e.g. doxorubicin, epirubicin
- antimetabolites, e.g. capecitabine, 5-fluorouracil, gemcitabine, methotrexate
- taxanes, e.g. docetaxel, paclitaxel, nab-paclitaxel
Targeted therapies used to treat advanced breast cancer include:
- bevacizumab, lapatinib and trastuzumab.
The selection of specific chemotherapy drugs, combinations, doses, schedules and durations is based on:
- the pathological characteristics of the tumour, especially whether it expresses higher-than normal levels of the HER2 protein (HER2-positive tumours)
- the clinical characteristics of the tumour, especially its extent and growth rate
- the woman's past exposure and response to chemotherapy
- quality of life considerations including unwanted effects of chemotherapy
- the woman's preferences
- the woman's age
- practical considerations.
For a summary of current evidence for endocrine therapy in advanced breast cancer, refer to NBOCC's* Recommendations for use of endocrine therapy for the treatment of hormone receptor-positive advanced breast cancer.2
For a summary of current evidence for trastuzumab in advanced breast cancer, refer to NBCC's* Recommendations for use of trastuzumab (Herceptin ) for the treatment of HER2-positive breast cancer.3
* In February 2008, National Breast Cancer Centre (NBCC), incorporating the Ovarian Cancer Program, changed its name to National Breast and Ovarian Cancer Centre (NBOCC). In July 2011, NBOCC amalgamated with Cancer Australia to form a single national agency, Cancer Australia, to provide leadership in cancer control and improve outcomes for Australians affected by cancer.