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Hormone Therapy As with its use in treating the primary cancer, hormone therapy is used with recurrent tumors that are estrogen- and progesterone-receptor-positive or of an unknown status. The treatment plan will be individualized for each patient. Usually women who respond best to hormone therapy at this time have had a disease-free interval of two years or longer and have disease primarily in bone, skin, lymph nodes and have no or minimal symptoms. Tamoxifen is the treatment of choice for postmenopausal women and is especially effective in treating soft tissue or bone metastasis. Should the recurrent tumor progress during tamoxifen therapy, other new hormone suppressing drugs are now available which are also effective in controlling the cancer or achieving a remission. Several of the new aromatase inhibitors, letrozole, anastrozole, and exemestane, are now approved by the FDA for first-line therapy in postmenopausal women with hormone receptor-positive or unknown status cancers instead of tamoxifen. The new hormone-altering drugs are well tolerated and are administered as a tablet. The choice of therapy will depend on the individual patient situation and the doctor's medical evaluation. Hormone therapy options for premenopausal women include tamoxifen and/or ovarian ablation (ovarian castration). Ovarian ablation can be accomplished by the surgical removal of the ovaries (oophorectomy), by a short course of radiation therapy, or by the administration of new drugs that stop the ovaries from functioning. The treatment objective of ovarian ablation is to shut down or block the ovaries from producing and secreting estrogen, the hormone that may be supporting the growth of the tumor. If estrogen is not available to the tumor, tumor regression usually occurs, and a positive response to the treatment is achieved. A combination of both tamoxifen and ovarian ablation may also be used, depending on the individual patient's situation. Chemotherapy As a systemic therapy, chemotherapy is used in recurrent or metestatic cancer to treat disease that has spread beyond the breast or chest region, especially when symptoms of the disease are present. Chemotherapy is used preferentially for women who have metastasis to vital organs such as the liver or lungs and are experiencing symptoms of their disease. Depending on the individual patient, chemotherapy may be given with hormone therapy if the tumor is extrogen receptor positive or unknown. Chemotherapy typically consists of a combination of drugs (as with adjuvant chemotherapy in early stage disease), although a single drug may be chosen. The same chemotherapy combination that was used to treat the first cancer may be used again if the patient responded well the first time and there has been an interval of 6 months or more since the last time the treatment was used. Chemotherapy is very effective in reducing and controlling the tumor and relieving any distressful symptoms for metastasis to major organs such as the liver or lungs. Chemotherapy is equally effective against disease in bone, soft tissues, nodes, etc. It also is commonly used when hormone therapy no longer works or the tumor does not respond to hormone therapy. The most common combination chemotherapy regimens used to treat recurrence and metastasis are the same as those used to treat primary breast cancer: CMF (cyclophosphamide, methotrexate, 5-fluorouracil with or without prednisone) CA (cyclophosphamide and Adriamycin ), CAF (cyclophosphamide, Adriamycin, and 5-fluorouracil), CEF CAF (cyclophosphamide, epirubicin, and 5-fluorouracil). Other drugs commonly used in advanced or metastatic breast cancer are the taxanes -- paclitaxel and docetaxel - as well as capecitabine, mitomycin-c, epirubicin, vinorelbine, gemcitabine and Herceptin for HER-2/neu positive cancers. High dose chemotherapy followed by bone marrow or stem cell transplant remains highly controversial in treating metastatic breast cancer as there is no proven survival benefit over standard chemotherapy. Due to the high cost, potentially life-threatening toxicities, and unproven benefit, this treatment is not recommended outside of a clinical research trial. Research studies are ongoing to determine its true value and place in the treatment of breast cancer.  This content is reviewed regularly. Last Updated 6/6/2007
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