Current status of salvage chemotherapy for refractory advanced breast cancer

The definition of refractory advanced breast cancer remains elusive. Because of different definitions of objective response, frequent lack of precision in defining the number of prior chemotherapies, and differing interpretations of 'anthracycline resistance,' the literature remains confusing. What does seem clear, however, is that clinically meaningful responses can be achieved with third-line (or higher level) chemotherapy, with response rates and survival durations similar to those seen with first-line chemotherapy for metastatic colon cancer and for non-small-cell lung cancer. Given the broad array of potential chemotherapeutic options, both with commercially available combinations and new, exciting investigational agents, more data from prospective trials and more detailed retrospective analyses of large series are needed before patients and health-care administrators can be advised as to when it would be more prudent to abandon cytotoxic palliative therapies in favor of supportive care options, such as hospice care.