Chemotherapy in Patients with Anthracycline and Taxane-Pretreated Metastatic Breast Cancer: An Overview

Anthracyclines and taxanes are cytotoxic agents commonly used for treatment of breast cancer, including in adjuvant, neoadjuvant, and metastatic settings. Each drug class is associated with cumulative and potentially irreversible toxicity, including cardiomyopathy (anthracyclines) and neuropathy (taxanes). This may either limit the duration of therapy for advanced disease, or prevent retreatment for recurrence if previously used as component of adjuvant or neoadjuvant therapy. Several classes of cytotoxic agent have been evaluated in patients with anthracycline and taxane-pretreated metastatic breast cancer (MBC), including other antitubulins (vinorelbine, ixabepilone, eribulin), antimetabolites (capecitabine, gemcitabine), topoisomerase I inhibitors (irinotecan), platinum analogues (cisplatin, carboplatin), and liposomal doxorubicin preparations. No trials have shown an overall survival advantage for combination chemotherapy in this setting, indicating that single cytotoxic agents should usually be used, expect perhaps for patients with rapidly progressive disease and/or high tumor burden.