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Journal of the National Cancer Institute Advance Access originally published online on August 5, 2009
JNCI Journal of the National Cancer Institute 2009 101(17):1174-1181; doi:10.1093/jnci/djp235
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© 2009 The Author(s).
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

COMMENTARY

International Guidelines for Management of Metastatic Breast Cancer: Combination vs Sequential Single-Agent Chemotherapy

Fatima Cardoso, Philippe L. Bedard, Eric P. Winer, Olivia Pagani, Elzbieta Senkus-Konefka, Lesley J. Fallowfield, Stella Kyriakides, Alberto Costa, Tanja Cufer, Kathy S. Albain, on behalf of the ESO-MBC Task Force

Affiliations of authors: Department of Medical Oncology, Medical Oncology & Translational Research Unit, Jules Bordet Institute, Brussels, Belgium (FC, PLB); Department of Medical Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (EPW); Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale Italiano, Viganello, Lugano (OP); Switzerland and Swiss Group for Clinical Cancer Research, Bern, Switzerland (OP); Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdannsk, Poland (ES-K); Department of Psycho-Oncology, Brighton & Sussex Medical School, University of Sussex, UK (LJF); European Breast Cancer Coalition, Nicosia, Cyprus (SK); European School of Oncology, Milan, Italy (AC); Maugeri Foundation Breast Unit, Pavia, Italy (AC); Department of Medical Oncology, University Clinic Golnik, Golnik, Slovenia (TC); Department of Medical Oncology, Loyola University Chicago Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, IL (KSA)

Correspondence to: Fatima Cardoso, MD, Medical Oncology & Translational Research Unit, Jules Bordet Institute, Boulevard de Waterloo 125, 1000 Brussels, Belgium (e-mail: fatima.cardoso{at}bordet.be).

Compared with treatment options for early-stage breast cancer, few data exist regarding the optimal use of chemotherapy for metastatic breast cancer (MBC). The choice of using a combination of cytotoxic chemotherapies vs sequential single agents is controversial. At the 6th European Breast Cancer Conference, the European School of Oncology Metastatic Breast Cancer Task Force convened an open debate on the relative benefits of combination vs sequential therapy. Based on the available data, the Task Force recommends sequential monotherapy as the preferred choice in advanced disease, in the absence of rapid clinical progression, life-threatening visceral metastases, or the need for rapid symptom and/or disease control. Patient- and disease-related factors should be used to choose between combination and sequential single-agent chemotherapy for MBC. Additional research is needed to determine the impact of therapy on patient-rated quality of life and to identify predictive factors that can be used to guide therapy.

Manuscript received May 11, 2009; revised May 11, 2009; accepted June 25, 2009.


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