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Recommendations for use of Chemotherapy

Summary of evidence

The statements and recommendations about the use of chemotherapy for women with advanced breast cancer are based on:

  • a review of 63 randomised trials of chemotherapy in metastatic breast cancer published between 2000 and 20074
  • a Cochrane review investigating single-agent versus combination chemotherapy for metastatic breast cancer5
  • a review of randomised trials comparing taxane-containing regimens for metastatic breast cancer6
  • a review of randomised trials of adding targeted agents to a chemotherapy regimen for metastatic breast cancer.7

Additional relevant articles and two significant abstracts, published after the completion of these reviews up until December 2009, have also been considered.

No trials have directly compared chemotherapy with best supportive care in women with advanced breast cancer. Strong indirect evidence that chemotherapy improves survival and quality of life comes from older randomised trials of different doses and durations of chemotherapy,1 and more recent trials comparing various chemotherapy regimens.

Chemotherapy improves overall survival and quality of life by reducing the tumour size, growth rate or both, in women with responsive tumours. However, chemotherapy can also cause adverse effects.1

Differences between the effect of various established chemotherapy drugs and regimens on overall survival are modest in women with advanced breast cancer. Treatment decisions should be based on consideration of the woman's specific circumstances, attitudes and preferences, as well as pertinent high-quality evidence from randomised trials.

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