Additional systemic treatment length of survival can be
(chemotherapy, hormonal therapy, or increased. combination of both) to improve Palliation: active total care of recurrence free and overall survival in patients whose disease is no longer responsive to curative treatment. breast cancer patients, after potentially curative local treatment of isolated LRR. Primary goals of Palliation: For Estrogen Receptor Positive patients: a. The goal of palliative care is achievement of the best possible quality a. Hormonal therapy is the initial systemic of life for patients and their families. treatment given. Control of pain and of other symptoms. b. Tamoxifen is the preferred first-line b. The WHO method of cancer pain relief hormonal therapy. Tamoxifen is given at a should be immediately started for all dose of 20 mg daily and is given patients with metastatic breast cancer who continuously even if there is complete complain of pain. response, until disease progression. 1. Systemic chemotherapy or hormonal c. For elderly postmenopausal women therapy survival benefit for patients with with long disease- free interval whose metastatic breast cancer. recurrence is confined to skin and soft tissue, locoregional treatment may not be done and tamoxifen alone may be given. In general, for patients with metastatic breast cancer, systemic chemotherapy may For Estrogen Receptor Negative be offered because it has been shown to patients: confer a modest survival benefit of 6-9 months. a. Chemotherapy may increase survival but the size and duration of the benefit is 2. Systemic chemotherapy or hormonal unclear. therapy as initial treatment modality for metastatic breast cancer METASTATIC BREAST CARCINOMA There was no convincing evidence to prove the superiority of Metastatic breast cancer is defined chemotherapy over hormonal as breast cancer occurring therapy or vice versa as initial anywhere in the body outside the treatment for metastatic breast breast and regional lymph nodes. cancer.
Common sites of distant spread of Treatment of systemic recurrence of
breast cancer are the bones, skin breast cancer did prolong survival and soft tissues, lungs / pleura, and enhanced quality of life but was liver and brain. not curative.
In general, when cancer has spread Hormonal therapy is generally
to distant sites, cure is no longer preferred to cytotoxic chemotherapy possible. However, palliation of especially for estrogen receptor symptoms can be achieved in most positive patients. patients and in some cases the 3. Survival benefits of the different hormonal therapies in metastatic breast 6. Other treatments which have shown cancer. survival or palliative benefits in metastatic breast cancer For patients in whom hormonal therapy is deemed appropriate: Breast cancer patients with metastases confined to the bones a. Tamoxifen is the preferred first-line had a median survival of 3-4 years. hormonal therapy for patients with metastatic breast cancer which are There is a long period of time estrogen receptor positive. wherein palliation can be done for symptoms, primarily pain, due to In women who had received prior bone metastases. tamoxifen therapy: a. Radiotherapy may be given to a. Progestins, aromatase inhibitors, symptomatic patients with bone metastases androgens or oophorectomy in for relief of symptoms. premenopausal women, can be offered. b. For patients with bone metastases, 4. Survival benefits of the different bisphosphonates may be given because chemotherapy regimens in metastatic they reduce the incidence of skeletal breast cancer. complications and decrease pain medication requirements; however, no For patients who are not candidates survival benefit has been seen. for hormonal treatment, chemotherapy may be offered.
a. Chemotherapy may increase survival but
the size and duration of the benefit is unclear.
b. There is no survival benefit among the
different polychemotherapy regimens. Continued therapy until disease progression is better compared to limited therapy.
5. Survival benefit of adding
chemotherapy to hormonal therapy or adding of hormonal therapy to chemotherapy.
a. The addition of chemotherapy to
hormonal therapy does not confer a survival benefit for patients with metastatic breast cancer who are already responding to hormonal therapy. Likewise, the addition of hormonal therapy to chemotherapy does not confer a survival benefit for patients with metastatic breast cancer who are already responding to chemotherapy.