Chemotherapy of advanced breast cancer: the place of active new drugs

Many women presenting with Stage 11 or III breast cancer will relapse following initial adjuvant therapy. As current standard therapy will not cure patients with metastatic disease, dose intensification and new cytotoxic agents are being studied extensively. These new agents include vinorelbine, paclitaxel, docetaxel, edatrexate, gemcitabine, the anthrapyrazoles and the camptothecins. Strong evidence of complete remissions with first line use, or palliative benefit following anthracycline therapy, would suggest incorporation in regimens early in the treatment cycle. Preliminary results of various combinations containing vinorelbine, paclitaxel, docetaxel with anthracyclines and cisplatin are promising. However, the first generation of randomized trials are incomplete and sufficient data should be accrued before new combination treatments are adopted as first-line therapy in routine practice.