Review of recent trials of chemotherapy for advanced breast cancer: Studies excluding taxanes

Randomised trials in advanced breast cancer have shown anthracycline regimens to be slightly superior to other combinations, but no difference has been established between the type of anthracycline used in combination. New combinations of existing drugs, with the introduction of carboplatin, 5- fluorouracil with leucovorin, and etoposide and ifosfamide in combinations, have been associated with response rates up to 89%. The value of high-dose regimens has been uncertain. However, a recently reported randomised trial [95] in which two high-dose therapies were compared with standard chemotherapy has shown an approximate doubling of the response rate, response duration and survival in favour of high-dose therapy. Response rates in locally advanced breast cancer given intensified therapy with or without HGF/PBSC support are at or near 100%. Of importance is the 20% pathological complete remissions seen with the best regimens. Neoadjuvant chemotherapy such as paclitaxel and doxorubicin and epirubicin, cisplatin, and fluorouracil and intensified regimens are associated with response rates at or near 100%. A randomised trial of preoperative versus post-operative chemotherapy shows a trend towards improved PFS in the former group [121]. Vinorelbine is highly active when used as a single agent and when incorporated into combination chemotherapy regimens. Gemcitabine, idarubicin and liposomally encapsulated anthracylines all look interesting and are awaiting further clinical investigations.