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New agents for systemic treatment of early and metastatic breast cancer

In the treatment of metastatic breast cancer considerable progress has been made in recent years. This is primarily due to the development of new agents including anthrapyrazoles, taxanes, liposomal anthracyclines, gemcitabine, anti-folic acid compounds, and new thymidylate synthetase inhibitors.

Another promising approach arises from new hormonal drugs like aromatase inhibitors and new SERMs (selective estrogen-receptor modulators) which share the antiestrogenic effect of tamoxifene in breast tissue, but without inducing proliferation of the endometrium. Although there are no randomised trials available for these new agents in the treatment of breast cancer, data from studies in the prevention of osteoporosis with raloxifene are quite encouraging, suggesting a prophylactic effect against the development of breast cancer.

A completely different therapeutic strategy compared to chemotherapy and hormonal therapy is the administration of monoclonal antibodies targeting HER-2/neu, an antigene that is overexpressed in certain patients. Weekly injection of these antibodies was associated with a greater than 10% response in patients with metastatic breast cancer. An augmentation could be observed when administering the antibody in combination with cisplatin yielding a response rate of 25%. New data presented at the ASCO-Meeting suggest that integration of anti-HER-2/neu therapy into regimens using conventional chemotherapy might lead to increased survival rates.

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