 Ixabepilone, a microtubule stabilizing agent, is indicated as monotherapy or in

combination with capecitabine. Eribulin is a second antimicrotubule agent approved as

monotherapy in patients who have received at least two prior chemotherapy regimens for
MBC.

Biologic or Targeted Therapy

- Three anti-HER2 agents are available: trastuzumab, lapatinib, and pertuzumab. The
majority of data supporting the role of these agents in MBC focuses on trastuzumab.
Trastuzumab produces response rates of 15% to 20% when used as a single agent and
increases response rates, time to progression, and OS when combined with
chemotherapy. It has been studied in doublet (taxane–trastuzumab and vinorelbine–
trastuzumab) and triplet (trastuzumab–taxane–platinum) combinations, but the
optimum regimen is unknown.
- Trastuzumab is well tolerated, but the risk of cardiotoxicity is 5% with single-agent
trastuzumab and unacceptably high in combination with an anthracycline.
- Lapatinib is an oral tyrosine kinase inhibitor that targets both HER2 and the epidermal
growth factor receptor. It demonstrated improved response rates and time to
progression in combination with capecitabine, as compared with capecitabine alone,
in patients previously treated with an anthracycline, taxane, and trastuzumab. The
most common adverse events were rash and diarrhea.
- Pertuzumab is a monoclonal antibody that binds to a different HER2 domain as
compared with trastuzumab. The NCCN guidelines include pertuzumab in
combination with trastuzumab plus a taxane.

Radiation Therapy
Commonly used to treat painful bone metastases or other localized sites of disease,
including brain and spinal cord lesions. Pain relief is seen in approximately 90% of patients
who receive RT.

PREVENTION OF BREAST CANCER

1. SERMs and AIs are being studied for pharmacologic risk reduction of breast cancer.
2. The most clinical information is available for the SERMs, tamoxifen and raloxifene,
which reduce the rates of invasive breast cancer in women at high risk for developing
the disease. Rates of endometrial cancer and deep vein thromboses are higher in
patients receiving tamoxifen, but the overall quality of life is similar between the two
agents.
3. Exemestane taken for 5-years significantly reduced the rates of invasive breast
cancers with tolerable adverse events. Clinical trials with other AIs are underway.

EVALUATION OF THERAPEUTIC OUTCOMES

EARLY BREAST CANCER
• The goal of adjuvant therapy in early-stage disease is cure. Because there is no
clinical evidence of disease when adjuvant therapy is administered, assessment
 of this goal cannot be fully evaluated for years after initial diagnosis and
treatment.
• Adjuvant chemotherapy can cause significant toxicity. Optimize supportive
care measures such as antiemetics and growth factors to maintain dose
intensity.

LOCALLY ADVANCED BREAST CANCER

• The goal of neoadjuvant chemotherapy in locally advanced breast cancer is cure. Complete
pathologic response, determined at the time of surgery, is the desired end point.

METASTATIC BREAST CANCER

Optimizing quality of life is the therapeutic end point in the treatment of
patients with MBC. Valid and reliable tools are available for objective
assessment of quality of life in patients with breast cancer.
The least toxic therapies are used initially, with increasingly aggressive
therapies applied in a sequential manner that does not significantly
compromise quality of life.
Tumor response is measured by changes in laboratory tests, diagnostic
imaging or physical examination.