The role of gemcitabine in the management of women with locally advanced and metastatic breast cancer

Prof Michael Friedlander
Department of Medicine, Prince of Wales Clinical School, Randwick, NSW

Cytotoxic chemotherapy plays an important role in the treatment of women with hormone-refractory or hormone-insensitive breast cancer. These agents have demonstrated benefits in providing symptom relief, temporarily reversing or delaying disease progression, and prolonging life1 with a small percentage of women with metastatic disease experiencing prolonged long-term survival. Patient or disease characteristics that have been associated with a reduced likelihood of therapeutic success include: poor performance status, multiple and/or visceral sites of disease, short disease-free or response intervals or the failure of a prior therapy.1 In patients with metastatic breast cancer, first-line therapy is generally associated with higher response than with secondline or subsequent therapies as is the case in most solid tumours.1

In women with metastatic breast cancer, the goals of treatment include prolongation of survival, and the improvement of quality of life, while at the same time trying to minimise the toxicity of treatment. Combination regimens are generally associated with higher response rates, and longer progression-free survival compared to monotherapy although the impact on overall survival is still debated.1 There are data to suggest that the use of continuous therapy in responding patients is associated with a prolonged disease free survival and improved quality of life compared to intermittent therapy with reintroduction of chemotherapy at the time of disease progression/recurrence.1 For women with metastatic disease,chemotherapy is generally associated with a median survival of about two years following the diagnosis of the first metastasis although this can be much longer in some women.

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