Second-line chemotherapy for metastatic breast cancer including quality of life issues

First-line chemotherapy for matastatic breast cancer extends median survival by 9-12 months. A small fraction of patients achieve long-term remission with standard chemotherapy. With second-line chemotherapies, there is an objective response of 25-50% with a median time to progression of 4-6 months. There is some evidence that quality of life is improved (or at least not compromised) by treatment needed to achieve this modest survival gain. Paclitaxel, novalbine, and docetaxol have anti-tumour activity in anthracycline-resistant patients. One hundred and thiry-four patients with anthracycline-resistant tumours treated with docetaxol showed a 41% complete or partial response, a median duration of response of 6 months, and 1-year survival rate of 43%. Docetaxol may have anti-tumour activity in patients failing paclitaxel, as preliminary data showed a small number of patients responded indicating a partial lack of cross resistance. Comparative studies are needed to determine the difference in efficacy and safety profiles of these two drugs. The role of these drugs in earlier stages of the disease, i.e. as adjuvant and neoadjuvant treatment needs to be evaluated.