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Breast cancer—advanced stage: “cure—still a long way to go?” 85 1 3 editorial Metastatic breast cancer (MBC) remains essentially in- curable, and goals of therapy include the palliation of symptoms, delay of disease progression, and prolongati- on of overall survival time without negatively impacting quality of life. ough numerous randomized clinical trials have shown improvements in overall response ra- tes, few have found clear survival benefits. In recent ye- ars, however, there has been a small but growing series of clinical trials demonstrating modest, but meaningful survival advantages in metastatic disease [1]. In addi- tion, the development of targeted biologic agents active against MBC, such as trastuzumab, has demonstrated great potential for enhancing the effects of chemother- apy and producing meaningful survival improvements, and thereby presents a new dimension [2]. Overall, 5–10 % of MBC patients survive more than 5 years, and 2–5 % survive more than 10 years. Recent studies suggest that the survival of patients with MBC has been slowly improving and there might be a possi- ble curative approach for a certain group of patients. An aggressive multidisciplinary approach including both local treatment of macroscopic disease and systemic tre- atment of microscopic disease can result in prolonged disease control in certain patients. We have observed that the patients most likely to benefit from such an aggressive approach are young and have good performance status, adequate body functio- nal reserve, long disease-free interval before recurrence, oligometastatic disease, and low systemic tumor load. Whether patients with prolonged disease control are “cured” remains controversial [3]. ere is no single standard of care for patients with MBC, as treatment plans require an individualized approach based on multiple factors. ese include speci- fic tumor biology, growth rate of disease, presence of vis- ceral metastases, history of prior therapy and response, risk for toxicity, and patient preference. Targeted biologic therapies offer an entirely new treatment dimension for patients with MBC. With targeted biologics, such as tras- tuzumab, the potential for enhanced or synergistic acti- vity is a compelling argument for the use of these agents in combination with traditional chemotherapeutics [2]. e assessment of the true survival benefits from che- motherapy in MBC can be difficult, given the potential for confounding issues, such as the impact of subsequent therapies. Nonetheless, there is an increasing number of randomized clinical trials that have documented signifi- cant survival differences [4]. Optimization of therapy for the treatment of MBC remains to be an ongoing effort. Further improvements are possible only through a better insight in the mole- cular genetics and cell biology of breast cancer develop- ment and progression. A further point in the improvement of therapy options next to the circumvention of the mechanisms of resis- tance and the expansion of the therapeutic spectrum of available medications can only be the identification of other additional valid targets, as has been shown in the example of Her2. is issue of MEMO is dedicated to new developments in the treatment of metastatic breast cancer reflecting the increasing knowledge and advances in this field. It was my great concern to pay special interest to current prac- tical issues. e increasing number of potential therapies and the effort to implement them in the most optimal man- ner again leads to a series of unanswered questions: Are there reliable predictive biomarkers and which role do memo (2012) 5:85–86 DOI 10.1007/s12254-012-0022-3 Breast cancer—advanced stage: “cure—still a long way to go?” Herbert Stöger H. Stöger, MD () Department of Oncology, Medical University Graz, Auenbruggerplatz 15, 8036 Graz, Austria e-mail: [email protected] Received: 8 May 2012 / Accepted: 14 May 2012 / Published online: 5 June 2012 © Springer-Verlag Wien 2012 Herbert Stöger
