BREAST-CANCER THERAPIES IN DEVELOPMENT - A REVIEW OF THEIR PHARMACOLOGY AND CLINICAL POTENTIAL

Although the management of breast cancer has improved over the past fe w decades, it remains an important challenge for the clinician. Cytoto xic chemotherapy and hormonotherapy, when given in the adjuvant settin g, have a definitive though modest impact on the outcome of early-stag e breast cancer. In metastatic disease, these therapies help to provid e substantial palliation of symptoms but have a limited impact on surv ival. The discovery of vinorelbine and the taxanes, paclitaxel and doc etaxel, certainly represented the most encouraging clinical developmen t of the 1980s in breast cancer therapy. Several other new cytotoxic a gents have been recognised for their potential in the treatment of thi s disorder. Many of them are only in a very early phase of their clini cal development and it remains to be proven that they will have a majo r role in daily practice in the near future. In terms of hormonal trea tment, new aromatase inhibitors and new antiestrogens have been develo ped and, to date, show equivalent efficacy compared with the more clas sical hormonal agents. Some of them may be substantially better tolera ted. Our increasing understanding of the process of metastasis, of the mechanisms of resistance of cancer cells and of cell transformation, proliferation and differentiation is now translating into several prom ising new treatment strategies for the management of breast cancer pat ients. Thus, the success of these promising new therapeutic agents and strategies, which have been identified over the past few years and ar e in various stages of clinical development, will certainly depend in part on their proper evaluation in well designed clinical trials.