The modern treatment of breast cancer started with the introduction of tamoxifen for hormone-sensitive breast cancer. A series of hormone treatment principles and chemotherapy regimens have since then been established. In more recent years, targeted treatment in the form of antibodies and small molecular agents has become available.
Localized breast cancer
The adjuvant treatment of localized breast cancer clearly results in a higher rate of cure. This is thoroughly documented in a world-wide cooperation where the results from a large number of randomized studies are collected.
Locally advanced breast cancer
Locally advanced breast cancer consists of tumors classified as T3 or T4 and/or breast cancer disease with locally advanced lymph node metastasis (N2-3), and without known distant metastasis. This patient group is heterogeneous.
There is no general consensus concerning treatment of patients with locally advanced breast cancer. Preoperative chemotherapy is recommended in most instances. For selected patients endocrine treatment is an alternative to chemotherapy. The treatment schedule is customized according to the recommendations of NBCG.
Metastatic/advanced breast cancer
Treatment of metastatic breast cancer is not curative.It is important with a total evaluation of the attributes for each patient’s cancer disease, extent of the disease, morbidity, and possibility for toxicity of treatment before a treatment plan is decided upon.
The principle for treatment of metastases is to utilize one treatment principle or drug at a time and to perform regular repeated evaluations of the effect. The treatment which stabilizes and leads to remission of the disease should be continued until progression. A comprehensive reassessment should then be performed before second line treatment is started.
The individual patient may benefit from multiple “treatment lines” to control the cancer. Still, there are large differences in effectiveness. The number of lines of treatment and their duration with beneficial effect will vary between patients.
Hormone treatments used
- Antiestrogens (fulvestrant, tamoxifen)
- Anti-aromatase drugs (anatrozole, exemestane, letrozole)
- Gestagens (megestrol acetate)
- Drug-induced, surgical, or radiotherapeutic sterilization