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Monotherapy of Metastatic Breast Cancer: A Review of Newer Agents

^a Columbia Cancer Research Network of Florida; Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Aventura, Florida, USA; ^b Northern Alberta Breast Cancer Program; Cross Cancer Institute; University of Alberta, Edmonton, Alberta, Canada

Correspondence: Charles L. Vogel, M.D., F.A.C.P., 2999 N.E. 191 Street, Suite 200, Aventura, Florida 33180, USA. Telephone: 305-674-3030; Fax: 305-466-9446.

Purpose. New agents for the palliative treatment of metastatic breast cancer have emerged in the 1990s. This review summarizes the response rates of these agents with an emphasis on recent findings, such as presentations from the 1998 Meeting of the American Society of Clinical Oncology.

Methods. The English medical literature was reviewed to identify clinical trials involving monotherapy for the treatment of metastatic breast cancer. Three agents—paclitaxel, vinorelbine, and docetaxel—are emphasized because their databases are extensive enough to allow interesting comparisons. Liposomal-encapsulated anthracyclines, losoxantrone, gemcitabine, oral surrogates of continuous-infusion fluorouracil, raltitrexed, LY 231514, edatrexate, topoisomerase I inhibitors, and trastuzumab are reviewed briefly.

Results. Many of the new agents produce response rates approaching or even surpassing those achievable with doxorubicin monotherapy. Compared with older agents, some new agents have improved or at least different safety profiles, and some are easier to administer.

Discussion and conclusions. The new agents offer useful therapeutic options that make them suitable for combining with each other and with older agents, which could result in more effective regimens for metastatic disease, and, ultimately, primary disease in the adjuvant setting. The chemotherapeutic paradigms governing the management of breast cancer for the past three decades are likely to change as we move into the 21st century.

Key Words. Breast neoplasms • Docetaxel • Paclitaxel • Vinorelbine • Review

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