An update on first line therapies for metastatic breast cancer

ABSTRACT

Introduction: In recent years, outcomes of patients with metastatic breast cancer (MBC) have improved due to a greater understanding of the mechanisms of carcinogenesis in the development of newer molecularly targeted drugs, especially those as a front-line therapy. Remarkable improvements have been made in the treatment of hormone receptor positive (HR+) and Her2 positive MBC and currently targeted treatment strategies represent a valid first line treatment.

Areas covered: Herein, the authors provide an overview of the first-line pharmacotherapies currently available for the treatment of MBC and provide their expert perspectives on the area.

Expert opinion: Decisions on the first-line treatment of MBC should consider the clinical features of the disease, but also the biological mechanisms that regulate tumor cell growth. New and effective therapeutic agents have recently been introduced in the first-line therapy of MBC. However, to optimize the treatment of patients with metastatic disease, clinicians need biomarkers of resistance or sensitivity to targeted therapies. Efforts must also be made in developing strategies to personalize treatments of MBC patients and to identify those patients who might gain the most benefit from new treatment interventions, to save costs and limit toxicity.

KEYWORDS:

• Metastatic breast cancer
• endocrine therapy
• antiHer2 therapy
• targeted therapies
• immunotherapy

Acknowledgment

We thank Mr Antonio Guadalupi for his support and assistance with the preparation of the manuscript.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or material discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Article highlights

• Considerable advances have been made in the first line therapy of metastatic breast cancer, especially Her2 positive and HR+

• First line therapy of HR+ metastatic breast cancer include combination of aromatase inhibitors with CDK 4/6 inhibitors and Fulvestrant high dose.

• Combination of trastuzumab, pertuzumab and taxane has significantly improved outcomes of Her2 positive MBC patients

• Triple-negative breast cancer represents a continuing challenge because, when compared with other subtypes, it is associated with a higher frequency of recurrence, shorter DFS and poor OS and lack of effective targeted strategies.

• Future research should explore biomarkers of sensitivity to first line targeted therapies to better identify those MBC patients who are likely to benefit more from new treatment options.

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Additional information

Funding

This manuscript has not been funded.