Metastatic breast cancer patients failing first-line, anthracycline-containing chemotherapy: Is further therapy of benefit?

During the last 50 years median survival for metastatic breast cancer has n ot varied and remains 2-3.5 years. To assess the clinical benefit of salvag e systemic therapy a retrospective analysis of metastatic breast cancer pat ients all homogeneously treated with a commonly used first-line anthacyclin e-containing cytotoxic regimen (FEC) was undertaken. The 140 patients in th is report were among 375 entered in two consecutive multicenter randomized trials carried out from Dec. 1983 to Jan. 1990. All patients died during fo llow-up. Median number of salvage therapies was 3 (range 1-7). Response rat e (CR and PR) was 41% with FEC and 7%, 3%, 15%, 0%, 14%, 0%, 0% in patients receiving salvage treatment line 1 to 7, respectively. Time to treatment f ailure (TTF) was 7.5 months for FEC and 3.5, 2.5, 2.1, 1.6, 2.1, 1.1, 1.6 m onths at first to seventh salvage treatment, respectively. Only a very smal l fraction of patients receiving first-line FEC respond to subsequent palli ative treatment. The advantages of salvage therapy are unclear and must be weighed against the inconvenience, cost and morbidity of treatment. After f irst salvage therapy, patients should be considered for randomized trials c omparing systemic antineoplastic therapy with best palliative care. Endpoin ts of all future clinical trials in metastatic breast cancer should include measurement of quality of life and accurate, sequential measurement of sym ptom control.