Systemic chemotherapy for advanced breast cancer

During a 20‐year period, 377 women with primary advanced or metastatic breast cancer were treated systemically by various chemotherapeutic agents and were considered suitable for a detailed analysis of therapeutic results. Fifty‐five (15%) of these patients experienced objective remission of palpable or demonstrable disease for 2 months and 10% for 6 months, but 19.6% died within one month after the initiation of treatment. It should be noted that 271 of the total patients in this study had been previously treated by additive or ablative hormone therapy and, at the time chemotherapy was given, a majority had multiple metastases and, in some instances, involvement of vital organs. Regardless of the type of chemotherapy, as well as the initial maintenance or total dosage, the poorest therapeutic results were obtained when the metastases were located in the bones, brain, or lungs with lymphangiectatic involvement and the liver with jaundice or abdominal ascites. The best results were observed when the cancer was located in nonvital soft tissues as well as nodular pulmonary metastases and the liver without associated functional complications. While there are controversial opinions regarding the need for toxic side effects in order to produce objective remissions, in our observations, dosages just below the level of toxicity in most instances produced almost equal therapeutic results. If there were failures to subtoxic doses, better results were obtained by using a different cytotoxic agent rather than increasing the amount of the initial drug. In this review, very few patients received simultaneously multiple anticancer drugs, and whether or not this would produce better results than successive use of single cytotoxic agents remains to be evaluated. The determination of which chemotherapeutic agent is most effective regarding the anatomical site of the breast cancer cells remains an unsolved problem. In this nonrandomized study, comparative results suggested that objective responses declined in the following order: methotrexate, Leukeran, Thio‐TEPA, Velban, 5‐fluorouracil, Cytoxan, and nitrogen mustard. It should be noted that the number of patients treated by each of these compounds varied considerably, and this may in part account for the differences in response rates. When chemotherapy was combined simultaneously with other palliative measures, the results in the chemotherapy group were improved but infrequently exceeded the response rates of those following the use of additive or ablative hormone therapy alone. While chemotherapy has contributed to the symptomatic and objective palliation of many patients with advanced breast cancers, our observations suggest that with few exceptions it should be used to supplement rather than to replace other measures. The exceptions apply to those patients who would be unable to tolerate other palliative procedures because of physical conditions from anatomical sites of metastases, advanced age, or unrelated complications.