1. Chemotherapy is an option for patients with clinically aggressive metastatic breast cancer or evidence of endocrine resistance.a
I
A
1
2. The optimal sequence of chemotherapeutic agents has not been established.b
II
A
2,3
3. Metronomic chemotherapy is an option for patients with advanced hormone-receptor positive disease.c, d
I
B
4,5
a.Please refer to previous points about the definition endocrine resistance
Anthracyclines (including liposomal doxorubicin) and taxanes (paclitaxel, docetaxel, nab-paclitaxel), vinorelbine, capecitabine, cisplatin/ carboplatin, gemcitabine, eribulin, and ixabepilone could be considered as options for MBCpatients when chemotherapy is considered.
Metronomic chemotherapy treatment refers to the chronic administration of low doses of chemotherapeutic agent(s). The availability of NHI coverage makes metronomic chemotherapy a reasonable alternative.
Metronomic chemotherapy regimens that have been validated in prospective clinical trials includes single agent oral vinorelbine and capecitabine or combinations such as oral methotrexate plus oral cyclophosphamide, oral vinorelbine plus capecitabine, oral cyclophosphamide plus capecitabine, and triple combination of oral vinorelbine, oral cyclophosphamide, and capecitabine.
References
ESMO Clinical Practice Guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer. A. Gennari, F. André, C. H. Barrios, et al. Ann Oncol 2021; 32(12), 1475-1495.
The first two lines of chemotherapy for anthracycline-naive metastatic breast cancer: a comparative study of the efficacy of anthracyclines and non-anthracyclines. WW. Chen, DY Chang, SM Huang, et al. Breast. 2013 Dec;22(6):1148-54.
5th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 5). F. Cardoso, S. Paluch-Shimon , E. Senkus, et al. Ann Oncol 2020; 31 (12): 1623-1649.
Metronomic chemotherapy. M.E. Cazzaniga , N. Cordani, S. Capici, et al. Cancers (Basel) 2021; 13(9):2236.
Efficacy of Metronomic Oral Vinorelbine, Cyclophosphamide, and Capecitabine vs Weekly Intravenous Paclitaxel in Patients With Estrogen Receptor-Positive, ERBB2-Negative Metastatic Breast Cancer: Final Results From the Phase 2 METEORA-II Randomized Clinical Trial. E. Munzone, M.M. Regan, S. Cinieri et al. JAMA Oncol. 2023 Sep 1;9(9):1267-1272.
