Reimer has received lecture fees and reimbursement of travel expenses from Novartis, Astra Zeneca, Pfizer, Sanofi-Aventis, and Roche. individual outweigh its adverse side effects. Endocrine treatment is usually indicated for all those patients whose tumors are hormone-receptor positive or of unknown Rabbit Polyclonal to ATP5I receptor status and who have enough time for a response to be seen. Chemotherapy should be given if the tumor is usually hormone-receptor negative, if a rapid response is usually urgently needed, or if endocrine treatment has failed to produce a response. Combination chemotherapy improves response rates and prolongs progression-free survival, yet it does not prolong overall survival in Ivabradine HCl (Procoralan) comparison to monochemotherapy. In HER2-positive patients, first-line treatment with trastuzumab and monochemotherapy prolongs overall survival. Other treatment options include angiogenesis inhibitors, various tyrosine kinases inhibitors, radiotherapy, bisphosphonates, surgical or other ablative treatment of metastases, or a combination of these approaches, applied either simultaneously or consecutively. Conclusions While locoregional recurrences of breast cancer should be treated with curative intent, breast cancer with distant metastases is currently not curable. It is treated with the intention of restoring and maintaining good quality of life and relieving symptoms due to the metastases, rather than prolonging survival. At present around Ivabradine HCl (Procoralan) 40% of all patients with breast cancer suffer a recurrence; most Ivabradine HCl (Procoralan) of them die from it (1, e1C e3). Breast cancer thus remains the most common cause of cancer-related death in women. The risk of recurrence is highest in the first 2C3 years and then decreases continuously, although Ivabradine HCl (Procoralan) it never reaches zero (e4). Ten percent to 20% of all recurrences are isolated locoregional recurrences, while 60% to 70% are distant metastases in one anatomical structure, or else in multiple locations (2, e4). The incidence and location of recurrences depend on the initial tumor stage, previous therapy, tumor biology, and the sensitivity of the diagnosis (table) (1, 3, 4, e5, e6) (Cheang et al.: Breast cancer molecular subtypes and locoregional recurrence. J Clin Oncol [Proceedings of ASCO] 26, [May 20 Suppl; Abstr 510] 2008). This article will give a systematic overview of treatment for recurrent breast cancer. Table Location and incidence of metastases found clinically and at autopsy in patients with metastatic beast cancer (2, 4) expression can change in the course of metastasization, determination of receptor status should always be carried out when recurrence occurs, if reasonably possible (EL 1/A AGO-GR++) (e8). In order to detect any further metastases, a re-staging procedure is recommended (chest radiography, bone scintigraphy and liver ultrasonography) (EL 5/D AGO-GR++), although this has not be shown to carry any survival advantage for the patient. Locoregional recurrence Local disease recurrence (Box 2) is generally treated curatively (9). In some cases it can be difficult to distinguish between a locoregional recurrence and an ipsilateral second tumor. Features suggesting a second tumorwhich like primary breast cancer should be treated curativelyare: Box 2 Definition of locoregional recurrence (9) Recurrence of disease: In the breast (after breast-preserving therapy) In the chest wall (after mastectomy) In the ipsilateral/parasternal/infra- or supraclavicular lymph nodes In the skin of the chest wall (not breast) In the reconstructed breast As a second carcinoma (e.g., angiosarcoma) A long interval of time since the first tumor A different location in the breast Different tumor biology (hormone-receptor status, HER2-receptor status, tumor grade). Five-year overall survival after an isolated chest wall recurrence is 68%; after intra-breast recurrence it is 81% (e4). Operable breast, chest wall, and axillary recurrences should be excised with tumor-free margins (EL 2b/A; AGO-GR++). For intra-breast recurrence, mastectomy is regarded as the standard treatment, although in some cases repeat breast-preserving surgery and interstitial radiotherapy may be undertaken (EL 3/C; AGO-GR+/C). The rate of repeat intra-breast recurrence is higher after such treatment (e9), but the significance of this for overall survival is unclear (6). Patients who have not yet received radiotherapy should be offered it (EL 2b/B; AGO-GR+). Antihormonal therapy after R0 resection of a locoregional recurrence with M0 status has prolonged the interval until a repeat recurrence, but without improving overall survival (EL 5/D; AGO-GR++) (10). No valid study results are available for chemotherapy or trastuzumab therapy after R0 resection of a local recurrence, so that these cannot be definitely recommended at present (EL.
Reimer has received lecture fees and reimbursement of travel expenses from Novartis, Astra Zeneca, Pfizer, Sanofi-Aventis, and Roche
