Targeting the right chemotherapy for the right patient

Excerpt

In the past few years breast cancer mortality has been declining in most Western countries as a consequence of better education, implementation of screening programs and more effective therapies. However, a small proportion of patients are metastatic at initial diagnosis (about 5–7%), and 25–30% of patients develop metastases following primary treatment. At this stage, the disease is considered incurable, the median survival ranges from 2 to 4 years, and a limited proportion of patients (about 20%) survive more than 5 years. In this scenario, it is important to identify the aims of treatment on the basis of individual patient needs. Data from clinical trials, meta-analyses, databases of large institutions, and cancer registries indicate that chemotherapy can prolong survival, and survival prolongation is associated with the activity of drugs [1‐5]. Moreover, those patients who achieve a complete response have about 20% chance of surviving beyond 5 years [6]. Finally, although there are few trials specifically addressing symptomatic control and quality of life, it is generally agreed that tumor shrinkage is associated with better control of symptoms, and that quality of life results from the balance between activity and tolerability of treatments. …