ABSTRACT
INTRODUCTION As patients with metastatic breast cancer (MBC) cannot be cured, the role of any treatment including cytotoxic chemotherapy is to maximise the duration of time without disease-related symptoms. This should be achieved with minimal toxicity from therapy in order that the quality of life can be maintained. It has been shown that the quality of life in advanced breast cancer is clearly linked with treatment response ( 1 – 3 ) and that chemotherapy can have a signifi cant benefi t for patients because of its anti-cancer effects that can reduce or prevent tumour-related symptoms. It has been questionable whether chemotherapy for MBC has any signifi cant benefi t in terms of overall survival, and the clinical trials of chemotherapy versus best supportive care have not been undertaken in this setting. However, historical comparisons have shown that the introduction of combination cytotoxic chemotherapy in the late 1970s has produced a modest 9-12 month gain in survival over untreated patients ( 4 , 5 ). Likewise, individual patients with life-threatening visceral disease who have a good clinical response to chemotherapy, will clearly have a survival benefi t compared with while not having the therapy. With the recent introduction of effective cytotoxic drugs and combinations, including those with biological agents, signifi cant impacts on survival are now being observed in individual trials compared with previous standard chemotherapy drugs. Therefore, it is likely that patients with MBC will derive signifi cant clinical benefi ts from modern-day chemotherapy. Finally, the plethora of drugs with non-cross resistant mechanisms of action, has given the oncologist several lines of therapy to offer patients.
