Continuation of chemotherapy after progression of advanced breast cancer

Abstract

The main purpose of metastatic breast cancer treatment is to prolong survival and preserve quality of life with reduction of the side effects associated with treatment. However, the optimal duration of chemotherapy and the choice of treatment regimen, especially first-line, remains debatable. There is also no conclusive evidence that maintenance chemotherapy prolongs overall survival (OS). A meta-analysis of trials that compared different chemotherapy durations in first-line treatment showed that the maintenance chemotherapy was associated with significant 36% reduction in the hazard of progression as compared with shorter chemotherapy duration. At the same time, longer chemotherapy was associated with marginally longer OS. The only randomised clinical trial to show significant OS benefit with maintenance chemotherapy was conducted in Korea. However, this trial evokes substantive doubts. In each case, the maintenance chemotherapy significantly increased the percentage of side effects. Due to the lack of conclusive evidence on the effectiveness of the maintenance, palliative chemotherapy continuing until disease progression. Patient selection for this form of therapy should be preceded by careful and reliable information about the possible benefits and the expected effects of treatment.