Treatment of Metastatic Breast Cancer Patients: What Is the Standard Care of the Patients?

The clinical course for breast cancer patients varies considerably. Some patients can be cured with minimal operation, while others quickly develop systemic dissemination and die over a few months. Some patients, even with metastatic disease, live long after systemic treatment, while no benefit from chemotherapy is observed in other subsets of patients. The most important goal of treating breast cancer patients is to stop metastasis at source, i.e. eradicate all cancer cells before they metastasize to distant organs. The principal strategy to achieve this goal has been 'detect and surgically excise the tumor as early as possible'. Based on this strategy, screening of breast cancer was successfully introduced for women aged 50 to 69 (1). Surgical operation has long been over valued for its role in controlling primary breast cancer since the radical mastectomy was first reported (2). Extent of primary breast surgery has been reduced from radical mastectomy to breast-conserving treatment without any disadvantage in controlling this disease. The shift in the operational mode occurred when it became recognized that treatment failure after breast cancer surgery usually is due to the systemic dissemination of cancer cells before surgery, rather than an inadequate operative procedure. The rationale for adding systemic therapy as a component of the initial treatment is that the prognosis of operable breast cancer patients is mostly governed by micrometastatic disease already existing at the time of initial diagnosis, even though no direct clinical evidence in diagnostic tests can be detected (3). Currently, systemic chemotherapy or endocrine therapy, combined with surgery and radiation therapy as the initial treatment of breast cancer, significantly reduce the recurrence and death rate in certain subsets of breast cancer patients. The highly diverse clinical outcome of breast cancer depends on a large number of factors, some are known, while without any doubt, many of them remain unclarified (4). Tremendous effort has been made to elucidate which patients are most likely to benefit from which treatments to prolong disease free survival and overall survival following the initial treatment for early breast cancer patients (5). However, a significant proportion of patients eventually still develop clinically overt metastatic disease, following the initial treatment complex. Metastatic breast cancer is generally recognized to be an incurable disease despite the recent advance in the treatment with endocrine and chemotherapy. The use of conventional chemotherapy or endocrine therapy in metastatic breast cancer is mainly for palliation. More than half the …